The usage of the intranet and its impact on organisational ... · UNIVERSITY OF TECHNOLOGY, SYDNEY FACULTY OF BUSINESS SCHOOL OF MANAGEMENT The Usage of the Intranet and its Impact

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The Usage of the Intranet and its Impact on Organisational Knowledge Sharing: An

Exploratory Investigation of a Public Hospital

By: Abdul-Hameed Jibril Oyekan

Supervisor:

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A Thesis Submitted for the Degree of Doctor of Philosophy,

University of Technology, Sydney

2007

I

Certificate of Authorship/Originality

I certify that the work in this thesis has not been previously submitted

for a degree nor has it been submitted as part of requirements for a

degree except as fully acknowledged within the text.

I also certify that the thesis has been written by me. Any help that I

received in my research work and preparation of the thesis itself has

been acknowledged. In addition, I certify that all information sources

and literature used are indicated in the thesis.

Signature of Candidate

-------------------------

II

CONTENTS

Dedication…III

Acknowledgements…IV

Table of Contents…V

List of Figures…XI

List of Tables…XIII

List of Appendices…XV

List of Acronyms…XVI

Glossary…XIX

Abstract…XXIII

III

DEDICATION

Dedicated to my parents, Dr. Abdullah Jibril Oyekan and Hajiya Fatima

Mahmud-Oyekan whose love for seeking and imparting knowledge continue to be

a source of inspiration to me

IV

ACKNOWLEDGEMENTS

It is impossible to thank everyone that has been a part of this stage of my life. As the

African proverb goes “it takes a whole village to raise a child”. There have therefore been

some special people who have nurtured me along the way. I must however first and

foremost thank the Almighty God for making this possible and blessing me with the

family, friends, colleagues that have helped me in their different ways in completing this

thesis. My heartfelt thanks to my supervisor, Professor Thomas Clarke who constantly

encouraged me when the going was tough, who pushed me when it was needed and

whose advice and critical evaluation over numerous meetings regarding the research was

invaluable over the past five years. I would also like to sincerely thank my co-supervisor

and good friend Dr. John Crawford who gave up many a weekend reading through my

write-ups. His deep and insightful views over our numerous discussions helped to shape

this thesis. I must also thank professional colleagues (academics and practitioners alike)

who at various stages were involved in discussing this research. My warm thanks go

especially to Professor Stewart Clegg and Dr Tyrone Pitsis for their support and advice

over the years.

A special thanks to my friends whose prayers and support helped to encourage me and

make things just that bit easier. My warm thanks to Riana, Yoshi and family in particular

for the friendship, lovely meals and vigorous discussions. My special thanks to Ms

Fadwa for the thesis editing, as well as the constant encouragement and support. My kind

thanks to Dr. Shehab and family for their friendship, support and unbelievable

hospitality. To the friends too numerous to mention who kept on asking: “have you

handed it in yet?” and continuously encouraged me, my heartfelt thanks. Finally and most

importantly, I would like to thank my family, my parents, my grandma, my brothers and

sisters, my uncles and aunties, my cousins and family friends, who constantly prayed,

called, worried and encouraged me. You all walked this journey with me though you

were on the other side of the world and I shall eternally be grateful.

V

TABLE OF CONTENTS

PART 1: INTRODUCTION TO THESIS AND LITERATURE REVIEW ............... 1

Chapter 1-Overview, Significance, Aims and Structure of the Thesis ............ 2

1.0 Chapter Introduction .................................................................................... 2

1.1 Overview of the Research ........................................................................... 4

1.2 The Research Problem .............................................................................. 11

1.3 Significance of the Research ..................................................................... 14

1.4 Overview of Research Structure and Aims ................................................ 17

1.5 Thesis Chapter Structure ........................................................................... 20

1.6 Conclusion ................................................................................................. 21

Chapter 2-Knowledge Management and the Intranet ......................................... 22

2.0 Chapter Introduction .................................................................................. 22

2.1 KM – A Background Look .......................................................................... 23

2.2 Defining Knowledge .................................................................................. 27

2.3 Knowledge Typology ................................................................................. 31

2.4 Defining KM ............................................................................................... 34

2.5 Knowledge Perspectives ........................................................................... 35

2.6 KM Processes ........................................................................................... 36

2.6.1 The Knowledge Conversion Model ........................................................... 38

2.7 The Intranet ............................................................................................... 42

2.7.1 Defining the Intranet .................................................................................... 44

2.7.2 Technical Characteristics of the Intranet .................................................. 48

2.7.3 Intranet Usage in Organisations ................................................................ 50

2.7.4 Multi-level Impact of the Intranet ................................................................ 53

2.7.4.1 Individual Level ...................................................................................... 53

2.7.4.2 Group Level ........................................................................................... 54

2.7.4.3 Organisational Level ............................................................................. 55

2.8 Linking the Intranet and KM ....................................................................... 56

VI

Chapter 3-The Australian Public Healthcare Sector, KM and the Usage of

the Intranet ..................................................................................................................... 67

3.0 Chapter Introduction .................................................................................. 67

3.1 The Characteristics of Public Sector Organisations and KM ..................... 67

3.2 An Overview of the Australian Public Healthcare Sector ........................... 73

3.2.1 Australian Public Hospitals ......................................................................... 74

3.3 Importance of KM in the Public Healthcare Sector .................................... 76

3.4 Australian Public Hospitals and the Potential Impact and Benefits of IT

Tools ............................................................................................................... 79

3.5 Intranet Usage in Australian Public Hospitals ............................................ 87

3.6 Enabling Organisational Conditions .......................................................... 96

3.6.1 Introduction .................................................................................................... 96

3.6.2 Knowledge Sharing Culture ........................................................................ 97

3.6.3 Structure ...................................................................................................... 100

Governing the Intranet ......................................................................................... 100

3.7 Conclusion ............................................................................................... 104

PART II- THE EMPIRICAL STUDIES .................................................................... 107

Chapter 4- Overview of the Empirical Research, Choice and Justification of

Methodology ................................................................................................................ 108

4.0 Chapter Introduction ................................................................................ 108

4.1 Choice and Justification of Research Methodology ................................. 108

4.1.1 Sample Selection ....................................................................................... 113

4.2 Overview of the Empirical Case Study .................................................... 114

4.3 Measures to Ensure Integrity and Validity of the Research ..................... 116

4.3.1 Ensuring Internal and External Validity ................................................... 116

4.3.2 Ethics Committee Approval, Data Security and the Researcher’s

Professional Background .................................................................................... 117

4.4 Summary ................................................................................................. 119

VII

Chapter 5- The City Hospital Intranet in Practice (Phase One) ..................... 120


5.1 The Aims of the City Hospital Intranet Background Study ....................... 120

5.2 Method .................................................................................................... 121

5.2.1 City Hospital Facilities Provided .............................................................. 122

5.3 Overview of the City Hospital .................................................................. 123

5.3.1 Organisational Structure and Lines of Responsibility ........................... 124

5.4 Overview of the City Hospital Intranet ..................................................... 125

5.4.1 History and Development .......................................................................... 125

5.4.2 Addressing Resistance to the City Hospital Intranet ............................ 126

5.4.3 Overcoming Technical Challenges .......................................................... 127

5.4.3.1 The New City Hospital Intranet Architecture .................................. 128

5.4.3.2 Accessibility and Usability ................................................................. 130

5.4.3.3 Security ................................................................................................. 132

5.4.3.4 Maintenance and IT Support ............................................................. 133

5.4.4 Overcoming Non-Technical Challenges ................................................. 137

5.4.4.1 User Involvement ................................................................................ 137

5.4.4.2 IT Contacts ........................................................................................... 138

5.4.4.3 Training ................................................................................................. 139

5.4.4.4 Ensuring Quality .................................................................................. 141

5.4.4.5 Ensuring Access ................................................................................. 142

5.4.4.6 Senior Management Support ............................................................ 142

5.4.4.7 IT Strategy ............................................................................................ 143

5.5 The City Hospital Intranet Evolves .......................................................... 144

5.5.1 Usage Level ................................................................................................ 146

5.5.2 Communication and Collaboration .......................................................... 147

5.5.3 Integrated Applications .............................................................................. 150

5.5.3.1 Clinical Applications ............................................................................ 150

5.5.3.1.1 CIAP ............................................................................................... 151

5.5.3.1.2 PowerChart ................................................................................... 152

5.5.3.1.3 Patient Management ................................................................... 153

VIII

5.5.3.1.4 PathNet ......................................................................................... 153

5.5.3.1.5 Inpatient Summary ...................................................................... 154

5.5.4 Human Resources Department ............................................................... 154

5.5.5 Finance Applications .................................................................................. 156

5.5.6 Operational and Managerial Reports ...................................................... 156

5.5.7 Support Services ........................................................................................ 157

Chapter 6-The Questionnaire-based Study (Phase Two) ................................ 160


6.1 The Aims of the Questionnaire-based Study ........................................... 160

6.2 Method .................................................................................................... 161

6.2.1 The Online Questionnaire ......................................................................... 161

6.2.2 Sample ......................................................................................................... 163

6.2.3 Procedure and Data Analyses ................................................................. 163

6.3 Findings ................................................................................................... 165

6.4 Summary of Findings .............................................................................. 176

Chapter 7-The Interview-based Study (Phase Three)....................................... 177


7.1 The Aims of the Interview-based Study ................................................... 177

7.2 Method .................................................................................................... 178

7.2.1 Sample ......................................................................................................... 179

7.2.2 Procedure and Data Analyses ................................................................. 181

7.3 Findings ................................................................................................... 184

7.3.1 The Definition of Knowledge and KM at the City Hospital ................... 184

7.3.2 Knowledge Sharing at the City Hospital ................................................. 185

7.3.2.1 The Types of Knowledge Shared at the City Hospital .................. 185

7.3.2.2 Knowledge Sharing within Departments ......................................... 187

7.3.2.3 Knowledge Sharing between Departments .................................... 189

7.3.3 Sources of Knowledge at the City Hospital ............................................ 192

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7.3.4.1 Non-Electronic: People ...................................................................... 192

7.3.4.2 Electronic: The City Hospital Intranet .............................................. 193

7.3.4 Usage of the City Hospital Intranet and its Impact on Knowledge

Sharing ................................................................................................................... 196

7.3.4.1 Socialisation ......................................................................................... 196

7.3.4.2 Externalisation ..................................................................................... 196

7.3.4.3 Combination ......................................................................................... 197

7.3.4.4 Internalisation ...................................................................................... 198

7.4 Key Influencing Factors Affecting Usage of the City Hospital Intranet for

Knowledge Sharing ....................................................................................... 199

7.4.1 Technical Barriers ...................................................................................... 200

7.4.1.1 Search Functionality ........................................................................... 200

7.4.1.2 Inability to Personalise Individual Intranet Websites ..................... 201

7.4.1.3 Layout Structure .................................................................................. 202

7.4.2 Non-Technical Barriers .............................................................................. 203

7.4.2.1 Lack of Time ........................................................................................ 203

7.4.2.2 Training ................................................................................................. 203

7.4.2.3 Lack of User Awareness of Benefits ................................................ 205

7.4.2.4 Professional Resistance .................................................................... 206

7.4.2.5 The Lack of a Clearly Defined KM Strategy ................................... 206

7.4.2.6 Inadequate Staffing and High Staff Turnover ................................. 207

7.4.2.7 Influence of Political Policies ............................................................. 209

7.4.3 Enabling Conditions ................................................................................... 210

7.4.3.1 Knowledge Sharing Culture .............................................................. 210

7.4.3.1.1 The Value of Knowledge Sharing and the Willingness to Share

......................................................................................................................... 210

7.4.3.1.2 Senior Management Support for Knowledge Sharing ........... 212

7.4.3.1.3 Reward for Knowledge Sharing................................................. 213

7.4.3.1.4 Viewing the Department and Hospital as One Team ............ 214

7.4.3.2 Intranet Structure ................................................................................ 215

7.4.3.2.1 Centralisation or Decentralisation ............................................. 216

X

7.5 Summary of Findings .............................................................................. 217

Chapter 8-Discussion and Conclusions .............................................................. 223


8.1 Discussion of Main Research Findings ................................................... 223

8.1.1 Research Questions Revisited ................................................................. 227

8.1.1.1 Research Question 1 .......................................................................... 227




8.2 Research Contributions ........................................................................... 273

8.3 Limitations and Directions for Future Research ....................................... 277

8.4 Conclusions ............................................................................................. 282

REFERENCES .............................................................................................................. 287

APPENDICES ............................................................................................................... 352

Appendix A- Online Questionnaire ................................................................ 352

Appendix B- Interview Information Statement ............................................... 360

Appendix C- Interview Consent Form ............................................................ 361

Appendix D- Interview Checklist .................................................................... 362

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LIST OF FIGURES Figure 1.1: Thesis Structure…….……………………...……………………………….. 32 Figure 2.1: Hierarchical Pyramid of Data, Information, Explicit Knowledge and Tacit Knowledge……………………………………………………………………………….58 Figure 2.2: Knowledge Conversion Model.……………...…...……………………….…68 Figure 2.3: Conceptual View of the Relationship between the Internet and Organisational Intranet…………………………………………………………………………………...73 Figure 3.1: A Schematic Healthcare Product System ……………………………….....106 Figure 5.1: City Hospital Organisational Structure and Lines of Responsibility………152 Figure 5.2: The New City Hospital Intranet Architecture………….…………………..156 Figure 5.3: Example of Department Page on the City Hospital Intranet...……………..160 Figure 5.4: IT Support Page on the City Hospital Intranet……………………………..162 Figure 5.5: Example of Service Links on the Division of Information Services Page on the City Hospital Intranet……………………………………………………………….164 Figure 5.6: Education and Training Page on the City Hospital Intranet…………….….168 Figure 5.7: Entry-Page of the City Hospital Intranet…………………………………...173 Figure 5.8: List of Linked Departments, Units, Institutes and Centres on the City Hospital Intranet………………………………………………………………………………….174 Figure 5.9: Number of Users and Hours Spent on the City Hospital Intranet………….174 Figure 5.10: Example of Groups, Committees and Projects Page on the City Hospital Intranet………………………………………………………………………………….175 Figure 5.11: Regular Updates Link on the City Hospital Intranet……………………...176 Figure 5.12: Example of Paging Page on the City Hospital Intranet…………………...177 Figure 5.13: Example of Forms Page on the City Hospital Intranet………………..….177 Figure 5.14: Example of Clinical IT Applications Page on the City Hospital Intranet...178 Figure 5.15: CIAP Entry Page………………………………………………………….179

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Figure 5.16: Employment Links on the City Hospital Intranet………………………...183 Figure 5.17: E-Manager Page on the City Hospital Intranet…………………………...183 Figure 5.18: Stores Link on the City Hospital Intranet………………………………...184 Figure 5.19: Staff Canteen Menu Page on the City Hospital Intranet………………….185 Figure 7.1: Metaphors used for Knowledge Sharing at the City Hospital….….…...…..208 Figure 8.1: Overview of Key Research Findings.……………………………….….…..300

XIII

LIST OF TABLES

Table 2.1: KM Categories and Potentials of IT Support………………………………...55 Table 2.2: Definitions of Knowledge…………………………………………………….57 Table 2.3: Knowledge Types……………………………………………………….........62 Table 2.4: Intranet User Modes………………………………………………………….79 Table 3.1: Studies of KM in Public Sector Organisations……………………………...100 Table 3.2: Public Hospitals - 2003-2004……………………………………………….103 Table 3.3: Adverse Impact of not Using IT in Hospitals……………………………….108 Table 3.4: Impact of IT Tools on Key Stakeholders in the Healthcare Industry ………111 Table 3.5: Intranet Applications in a Hospital...………………………………………..115 Table 3.6: Studies of Intranet Usage in Hospitals……………………………………....120 Table 6.1: Classification of Respondent Positions in the City Hospital….....………….193 Table 6.2: Classification of Respondents Specializations in the City Hospital………...193 Table 6.3: Sources of Knowledge Critical in the Carrying out of Respondents’ Daily Work in the City Hospital………………………………………………………………194 Table 6.4: Level of Use of Different Mediums for Knowledge Sharing with People within the City Hospital ……………………………………………………………………….195 Table 6.5: Frequency of Intranet Access for Daily Work by Respondents’ in the City Hospital…..……………………………………………………………………………..196 Table 6.6: Average Time Spent Weekly on the City Hospital Intranet by Respondents………………...…………………………………………………………..196 Table 6.7: Frequency of Respondents Access and Usage of the City Hospital Intranet Features ………………………………………………………………………………...197 Table 6.8: Results of Respondents’ Rating of Current Experience with the City Hospital Intranet………………………………………………………………………………….198 Table 6.9: Respondents’ Rating of Factors for Improved Usage of the City Hospital Intranet……………………………………………………………………………….....199

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Table 6.10: What Respondents Find Useful and Important about the City Hospital Intranet………………………………………………………………………………….200 Table 6.11: Factors that Impede the Usage of the City Hospital Intranet. ………………………………………………………………………………………..…201 Table 6.12: Other Comments by Respondents about their Experiences with the City Hospital Intranet……………………………………………………………………..…202 Table 7.1: Interviewees Sample Classification and Numbers………………………….208 Table 8.1: Human-based Knowledge Sharing Mediums at the City Hospital…….........270 Table 8.2 Summary of the Technical and Non-Technical Barriers Affecting the Usage of the City Hospital Intranet for Knowledge Sharing…………………………...……...…278

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LIST OF APPENDICES

Appendix A - Online Questionnaire

Appendix B - Interview Information Statement

Appendix C - Interview Consent Form

Appendix D - Interview Checklist

XVI

LIST OF ACRONYMS

ABS: Australian Bureau of Statistics

ACS: Australian Computer Society

ADX: Australian Derivatives Exchange

AHCRA: Australian Health Care Reform Alliance

AHP: Allied Health Professionals

BPR: Business Process Re-engineering

CINAHL: Cumulative Index to Nursing and Allied Health

CoI: Communities of Interest

CoP: Communities of Practice

E-mail: Electronic Mail

EMR: Electronic Medical Records

ERP: Enterprise Resource Planning

FAQ: Frequently Asked Questions

GDP: Gross Domestic Product

GP: General Practitioner

HTML: Hypertext Markup Language

HTTP: Hypertext Transfer Protocol

HR: Human Resources

HIMSS: Healthcare Information and Management Systems Society

HIS: Hospital Information System

IBM: International Business Machines

IT: Information Technology

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ITS: International Treasury Services

IS: Information Systems

KM: Knowledge Management

LAMP: Linux Apache MySQL PHP

LDAP: Lightweight Directory Access Protocol

MCP: Microsoft Certified Professional

MCSE + I: Microsoft Certified Systems Engineer + Internet

MEDLINE: Medical Literature Analysis and Retrieval System Online

NEHTA: National E-Health Transition Authority

NOIE: National Office of the Information Economy

NSW: New South Wales

NSW Health: New South Wales Health Department

OECD: Organisation for Economic Cooperation and Development

PBS: Pharmaceutical Benefits Scheme

PC: Personal Computer

PDF: Portable Document Format

PHP: Hypertext Preprocessor

PUMA: Public Management Service

ROI: Return on Investment

SD: Standard Deviation

SECI: Socialization, Externalization, Combination and Internalization

SEDL: Southwest Educational Development Laboratory

SMTP: Simple Mail Transfer Protocol

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TCP/IP: Transport Control Protocol/Internet Protocol

TQM: Total Quality Management

URL: Uniform Resource Locator

UTS: University of Technology, Sydney

XML: eXtensible Markup Language

XIX

GLOSSARY

Bandwidth: How much information (text, images, video, and sound) can be sent through

a connection. Usually measured in bits-per-second.

Browser: An application used to view information from the Internet. It provides a user-

friendly interface for navigating through and accessing the vast amount of information on

the Internet.

Browsing: A term that refers to exploring an online area, usually on the World Wide

Web.

Client/Server: A relationship in which one computer program (the client) requests

information from another computer program (the server), whereby the server responds in

fulfilling the request.

Client/Server Architecture: The design model for applications running on a network.

CD-ROM: Compact Disk-Read Only Memory, a storage medium popular in computers.

E-mail: Electronic Mail, text files that are sent from one person to another.

Emoticons: The online means of facial expressions and gestures e.g. .

Firewall: A security barrier placed between an organisation's internal computer network,

usually an Intranet, and the Internet. It consists of one or more routers which accept,

reject or edit transmitted information and requests.

Forms: The pages in most browsers that accept information in text-entry fields.

Gateway: A link from one computer system to a different computer system.

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Hits: An action on the website, such as when a visitor views a page or downloads a file.

Home Page: The page designated as the main point of entry of a website (or main page)

or the starting point when a browser first connects to the Internet. It provides links to the

lower-level pages of the site.

HTML: HyperText Markup Language (HTML) is a coding language used to make

hypertext documents for use on the Web. HTML allows text to be ‘linked’ to another file

on the Internet.

HTTP: HyperText Transfer Protocol (HTTP) is the standard Internet protocol for the

exchange of information on the World Wide Web.

Hyperlink: This is the clickable link in text or graphics on a web page that takes you to

another place on the same page, another page or a whole other site. It is the single most

powerful and important function of online communications.

Internet: A collection of over 60,000 independent, inter-connected networks that use the

TCP/IP protocols. It is a worldwide system of computer networks providing reliable and

redundant connectivity between disparate computers and systems by using common

transport and data protocols.

Intranet: Intranets are private networks, usually maintained by organisations for internal

communications, which use internet protocols, software and servers. They are relatively

cheap, fast, and reliable networking and information warehouse systems that link offices

around the world. They make it is easy for users to communicate with one another, and to

access the information resources of the internet.

Keyword: A word or phrase used to focus an online search.

Link: An electronic connection between two websites.

XXI

Load: Refers to transferring files or software from one computer or server to another

computer or server. Usually used with up-load or down-load In other words, it's the

movement of information online.

Log or Log Files: A File(s) that keep track of network connections or activities.

Login: The identification or name used to access a computer, network or website.

Mailing List: An automatically distributed E-mail message on a particular topics going

to certain individuals online.

Metadata: Data that describes other data.

Page Views: Number of times a user requests a page.

PDF Files: Adobe's Portable Document Format is a translation format used primarily for

distributing files across a network, or on a website.

Protocol: A set of rules that govern how information is to be exchanged between

computer systems.

Push: Is the delivery (‘pushing of’) of information that is initiated by the server rather

than being requested (‘pulled’) by a user.

Router: The hardware or software that handles connections between networks online.

Search Engine: A program that searches documents for specified keywords and returns a

list of the documents where the keywords were found. Although a search engine is really

a general class of programs, the term is often used to specifically describe systems like

Google that enable users to search for documents on the World Wide Web.

XXII

Server: Servers are the backbone of the Internet. These are computers that are linked by

communication lines that ‘serve up’ information in the form of text, graphics and

multimedia to online computers that request data.

TCP: Transmission Control Protocol works with IP to ensure that packets travel safely

on the Internet. This is the method by which most Internet activity takes place.

Upload: To send a file from one computer to another via modem or other

telecommunication method.

URL: Uniform Resource Locator, an HTTP address used by the World Wide Web to

specify a certain site. This is the unique identifier, or address, of a web page on the

internet.

Visits: A sequence of requests made by one user at one site.

Web page: A HTML document on the web, usually one of many together that makeup a

website.

Webmaster: The individual assigned to administering an organisation's website.

Website: The virtual location for an organisations presence on the World Wide Web,

usually making up several web pages and a single home page designated by a unique

URL.

World Wide Web: The World Wide Web allows computer users to access information

across systems around the world using URLs to identify files and systems and hypertext

links to move between files on the same or different systems. The web is a client/server

information system that supports the retrieval of data in the form of text, graphics and

multimedia in a uniform HTML format.

XXIII

Abstract

In this modern era, knowledge is considered a key economic resource. Its effective

management is viewed as a crucial source of value and competitive advantage for

organisations, by enhancing individual employee and core organisational competencies.

Knowledge-based organisations such as hospitals are prime examples of organisations

where access to and the sharing of knowledge is critical. In the public healthcare industry

in particular, Information Technology (IT) tools are viewed as a crucial ingredient in the

functioning of healthcare services (Haux, 2006; Kankhar, 2006; Pluye et al., 2005;

Ammenwerth et al., 2003). Many organisations have embraced the Intranet with the

intent to harness the technology to support Knowledge Management (KM) initiatives

(Oliver & Kandadi, 2006; Spies et al., 2005). Touted as the ‘killer application’ for

knowledge management (Cohen, 1998), the Intranet is said to have the potential of

enabling organisations to improve communication and collaboration among employees,

thereby increasing productivity and providing significant savings in time and money.

Through the efficient and effective sharing of knowledge, the Intranet can facilitate the

provision of better care by healthcare practitioners and inevitably save lives.

Despite its significance, little evidence exists in the extant literature on the application of

KM or IT tools such as the Intranet to support KM in public hospitals. Although the

potential benefits that IT tools such as the Intranet hold in supporting KM continue to be

highlighted in popular media and practitioner literatures, there have been relatively few

studies on Intranet usage in supporting KM particularly knowledge sharing in public

hospitals. In addition, Australian public hospitals in particularly have been viewed as

XXIV

going through a ‘crisis’ (Fett, 2000). A shortage of skilled staff, increasing medical errors

and under-funding has led to the need to do more with fewer resources. This has led to an

increased significance in the usage of IT tools like the Intranet to support knowledge

sharing. Accordingly, there is a need to gain insight into the usage and impact of the

Intranet on knowledge sharing in such a dynamic and critical work environment.

Previous studies suggest that the successful adoption and usage of IT tools require certain

pre-existing organisational conditions (see Berg et al., 1998; Malhotra, 2005; Al-Gharbi

& Alturki, 2001). Moreover, Ang et al. (2001) in a study on IT usage in the public sector

found organisational factors to have a greater influence on the use of IT than other

factors. In the area of health, organisational issues need to be taken into consideration as

they account for many of the difficulties and failures involving IT implementation and

usage (Haux, 2006; Andersson et al., 2003; Berg, 2001; Berg, 1999). Although there are

no specific set of organisational issues (Berg, 1999), there are key enabling conditions

that more commonly tend to be in place in an organisation for the effective usage and

impact of IT tools such as the Intranet. Researchers (i.e. Mantzana & Themistocleous,

2005; Snis & Svensson, 2004; Ammenwerth et al., 2003) identify culture and structure in

particular as crucial factors for the effective usage of IT.

An exploratory empirical case study comprising of three phases was adopted for this

research. A combination of quantitative and qualitative research methods were designed

and conducted to answer the following research questions:

1. What is the nature of the Intranet used at the hospital?

2. How is the Intranet used at the hospital?

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3. What is the impact of the Intranet on knowledge sharing within the hospital?

4. What are the factors influencing the usage of the Intranet for knowledge sharing within

the hospital?

The first phase of the research gathered background information on the research setting

and enabled an understanding of the structure and operations of the hospital and the

Intranet. This phase involved a combination of preliminary interviews with key IT

personnel involved in Intranet administration and development, personal observations by

the researcher, usage and features demonstrations of the Intranet and a review of key

hospital documents (e.g. annual reports, strategic plans and Intranet logs).

The second phase of the research explored the opinions of respondents towards various

issues relating to the usage of the Intranet in the hospital. An online questionnaire was

administered with a combination of closed and open-ended questions. A large number of

users were able to share their opinions on the advantages and disadvantages of using the

hospital Intranet. Research findings from this phase identified some key difficulties.

These were investigated in the third and final phase of the case study.

The third phase of the research involved a further investigation of the difficulties

experienced by Intranet users in the previous phase using a qualitative approach

involving semi-structured in-depth interviews. This phase also examined the Intranet’s

impact on the modes of knowledge sharing as represented in Nonaka & Takeuchi’s

(1995) knowledge conversion model.

XXVI

The overall results of the research revealed that the Intranet is part of an eclectic mix of

knowledge sharing mediums used at the hospital. Of critical importance and popular

usage by employees was human-based knowledge sharing mediums such as face-to-face

conversations. The findings indicate that these collegial modes of discourse and learning

are valuable, particularly in the sharing of tacit knowledge that is crucial in such a

dynamic work environment. It importantly highlights the oral nature of the medical

profession and the versatility in knowledge sharing at the hospital, an aspect that is

continuously emphasised as critical in other professions.

In addition, the various features of the Intranet were found to enable communication and

collaboration within the hospital. The results of the research showed that the Intranet

positively impacted on knowledge sharing by influencing the socialisation,

externalisation, combination and internalisation modes of the Nonaka & Takeuchi’s

(1995) knowledge conversion model. However, this impact was limited by certain

technical and non-technical factors. Accordingly, the need was demonstrated to enhance

the integration of the Intranet with popular knowledge sharing mediums such as face-to-

face conversations. The Intranet could supplement these mediums by facilitating

collegiality over distances, asynchronous time communication and collaboration, multiple

contacts and permanent records. This was expected to ensure the sustainable usage of the

Intranet for knowledge sharing.

The results also importantly uncovered several enabling and impeding factors influencing

the usage and impact of the Intranet at the hospital. User involvement in the development

and administration of the Intranet played a key factor in its popular usage in the hospital.

XXVII

Usage of the Intranet was also supported by senior management and a culture at the

hospital that valued knowledge sharing. Employees viewed the hospital as one team with

the common end goal of serving the children. Several impeding factors were revealed

from the research as recurring themes and were categorized as technical and non-

technical barriers. The most significant technical factor impeding the usage of the

Intranet for knowledge sharing was poor search functionality. Others included the

inability for users to personalise individual Intranet websites as well as the limitations

placed by a rigid layout structure of the Intranet. Time constraints were viewed as a key

non-technical factor impeding usage of the Intranet at the hospital. Other non-technical

factors included the lack of a clearly-defined KM strategy, inadequate user training, a

lack of user awareness of Intranet benefits for facilitating KM, inadequate staffing and

high staff turnover, the influence of political policies and professional resistance.

Several researchers have drawn attention to the lack of research conducted on the usage

of IT for facilitating KM and have called for more studies (e.g. Alavi, 2000; Gottschalk,

2000; Borell et al., 2001; Stoddart, 2001; Gallupe, 2001; Alavi & Leidner, 2001).

Additionally, few studies have focused on the usage of IT tools to support KM in public

healthcare sector organisations such as hospitals (Van Beveren, 2003). The results of the

research contribute to research in this area and add to the ongoing debate on the usage,

level of impact, possibilities for, and limitations of IT support for KM in such

organisations. Furthermore, the thesis contributes to the even smaller body of knowledge

on the usage of IT tools to support KM in public hospitals, especially in Australia where

public sector organisations have been slow in adopting IT. The findings of this research

XXVIII

provide critical insight into the current nature and extent of Intranet usage at a public

hospital and the influencing factors affecting its usage for knowledge sharing.

The methodological contribution of the research lies in the variety of approaches adopted.

A combination of research methods was utilised, including a questionnaire-based survey,

face-to-face interviews, personal observations, usage demonstrations of the Intranet,

strategic hospital documents and Intranet log reviews and consultation with experts. This

enabled an ‘immersion’ into the research setting and the ability to probe more deeply than

is possible with singular research methods. It therefore facilitated the obtaining of rich

data and facilitated a deeper understanding of the usage and impact of the Intranet on

knowledge sharing in the hospital.

From a practice perspective, the research findings have important implications for the

development, administration and usage of IT tools for supporting KM in public

healthcare organisations in Australia. The results of this research support and extend the

argument that IT tools that facilitate KM must take into consideration the technical and

non-technical organisational factors that could affect usage. The results therefore

highlight the importance of a knowledge sharing culture and a flexible, context-

dependent structure governing the usage of the Intranet. This thesis also acknowledges

the critical need for the Intranet to complement and enhance informal contacts among

employees. The addressing of these issues is pivotal to realizing the full potential and

benefits of advanced IT tools such as the Intranet for knowledge sharing.

1

PART 1: INTRODUCTION TO THESIS AND LITERATURE

REVIEW

2

Chapter 1-Overview, Significance, Aims and Structure of

the Thesis

1.0 Chapter Introduction

The purpose of this chapter is to provide a general introduction to the thesis. Firstly, an

overview and rationale of the research is presented. Secondly, the significance of the

research is established. The broad aims of the thesis are to investigate the usage and

impact of the Intranet on the creation and sharing of knowledge as well as the ways in

which surrounding organisational conditions facilitate or impede these processes.

The outline of the thesis structure as indicated in Figure 1.1 below includes Part I of the

thesis which covers the introduction to the thesis and the literature review. The

introduction presents a background to the research and a description of the research

problem. The literature review covers an examination and analysis of the related KM,

Intranet and public healthcare literatures. This is followed by Part II of the thesis which

covers the empirical studies carried out in the research. This part begins with an overview

of the empirical research conducted as well as the choice and justification of research

methods used. It presents the descriptions of the objectives for the three phases of the

research, the methods utilised in each phase and findings. Part II of the thesis

subsequently provides a discussion of the research findings, the contributions to research,

the research limitations, areas for future research and thesis conclusions.

3

PART I: INTRODUCTION TO THESIS AND LITERATURE REVIEW

CHAPTER THREE:

KNOWLEDGE MANAGEMENT IN

THE PUBLIC SECTOR, INTRANET USAGE IN PUBLIC

HEALTHCARE AND INFLUENCING CONDITIONS

CHAPTER SIX:

PHASE TWO:

THE QUESTIONNAIRE -

BASED STUDY, AIMS, METHOD AND RESULTS

CHAPTER ONE:

BACKGROUND, OVERVIEW AND STRUCTURE OF THE

THESIS

PART II: THE EMPIRICAL STUDIES

CHAPTER FIVE:

PHASE ONE:

THE INTRANET IN

PRACTICE, AIMS, METHOD AND

RESULTS

CHAPTER SEVEN:

PHASE THREE:

THE INTERVIEW –

BASED STUDY, AIMS, METHOD AND RESULTS

CHAPTER FOUR:

OVERVIEW OF THE RESEARCH, CHOICE AND

JUSTIFICATION OF METHODS

CHAPTER TWO:

KNOWLEDGE MANAGEMENT,

KNOWLEDGE SHARING, THE

INTRANET AND IT USAGE FOR

KNOWLEDGE MANAGEMENT

CHAPTER EIGHT:

DISCUSSIONS AND CONCLUSIONS

Figure 1.1: Thesis Structure

4

1.1 Overview of the Research

The increasingly globalised and turbulent business environment facing many

organisations today has led to an augmented focus on KM as a critical source of value

and competitive advantage (Alavi & Leidner, 2001; Davenport & Prusak, 2000; Newell

et al., 2001). Knowledge and KM are not new concepts and have always been critical

ingredients for economic success. This is because organisations across a variety of

industries have continually engaged in the creation, sharing and application of knowledge

(Alavi & Tiwana, 2003).

There has however, been critical recognition in both business and academic communities

for the need to focus the leveraging of organisational knowledge, viewed as the main

driver of organisational growth and competitiveness (Bhatt, 2001; Edenius & Borgerson,

2003). Knowledge is considered the source of value fuelling the transition from the

traditional industry-based economy to a knowledge-based economy (Spears, 2002). This

realisation has led to a plethora of academic articles on KM, including billions of dollars

in investments by organisations in various industries. The ‘awareness’ of KM benefits

and related initiatives have largely been implemented in private sector organisations.

Furthermore, the potential of KM in the public sector has also been stressed as a crucial

means to enable the necessary organisational transformation needed to strengthen

organisational capabilities and core competencies of public organisations (Al-Hawamdeh,

2002; Gramatikov, 2004).

5

According to Al-Hawamdeh (2002), this renewed focus on KM in the public sector has

largely been driven by the need for cost cutting measures to improve public sector

efficiency and effectiveness, the increasing demands for accountability, competition

between public sector organisations for resources and competition with private sector

organisations for the delivery of services. This has made leveraging knowledge a critical

determinant of competitiveness and survival for public sector organisations. The

development and popularity of initiatives such as ‘e-government’ is an example of ways

in which governments seek to cost-effectively improve knowledge sharing by providing

essential information to citizens, businesses and other key stakeholders (West, 2000).

A healthcare service delivery facility such as a hospital is viewed as a knowledge-based

organisation (Southon et al., 1999). It is considered to be an environment that is

conducive to KM, with its existence depending on it (Van Beveren, 2003). Clinical and

other healthcare related work performed in a hospital is highly specialised. It depends

heavily on the expertise of staff with high levels of skill and education to carry out

knowledge-based tasks (Berg, 1999). Hospitals are also profoundly dependent on rich

and accurate information. In order to be efficient and effective, competitive silos of

ignorance cannot be tolerated and could lead to drastic consequences, especially in a

hospital context. State-of-the-art knowledge originating from a myriad of different

contexts and sources are stored in dynamic IT systems and shared across multiple

organisational levels (Andersson et al., 2003). The sharing and creation of knowledge in a

hospital is therefore a key focus (Berg, 1998; Booth & Walton, 2000; Wyatt & Liu,

2002).

6

The unprecedented pace of change and advancement in IT tools has proved to be a

profound defining force opening the way for competitive differentiation and

organisational change (Yakhlef, 2005). Considered to be as sweeping in scope as the

communication explosion that resulted from the printing press, the implications of IT

tools can be viewed as similar to those that led to the industrial revolution. They have

dramatically changed the way people work, the skills they need and the views they hold

on what constitutes value and status (Telleen, 1996). The Internet and web-enabled

technologies in particular have been described as being among the greatest technological,

economic and social forces of the twenty-first century affecting all facets of daily work

and life (Castells, 2000; Wellman & Haythornthwaite, 2002).

The convergence of modern IT tools with the Internet has opened up new possibilities for

synergistic developments in and across organisations. With modern IT tools, people and

knowledge are coming together in novel combinations to deliver needed solutions which

enable rapid changes and adaptations. Houghton (2002) citing a PriceWaterhouseCoopers

(1999) report explained that this convergence was not just accelerating the rate of change,

but was also magnifying the impact of each individual change. When used collectively by

an organisation’s members, IT tools have the potential to not only transform the way

workers in these organisations think, interact and carry out their tasks but to also

transform the organisations themselves. Organisations are therefore able to become more

adaptable, responsive and ultimately more competitive.

7

IT tools have also been described as a critical for supporting KM (Metaxiotis et al., 2005;

Edwards et al., 2005). As Alavi & Leidner (2001) point out, IT tools can facilitate

collaboration and communication thus enabling knowledge sharing among users. They

therefore allow highly knowledgeable individuals and work groups to be brought together

and given direct access to the most intelligent internal and external knowledge sources

(Rollo & Clarke, 2001). They also facilitate the storing and categorising of large amounts

of information that can later be retrieved and shared across different contexts in a variety

of formats (Ellingsen, 2003; Houghton, 2002). Their effective usage has spurred new

forms of inter- and intra-organisational access, connectivity and interaction on previously

unimaginable scales. Consequently, organisations are able to provide access to and

integrate critical software applications, providing the means to support interactivity

between employees, partners and customers. It has therefore been argued that the role and

impact of modern IT tools and other web-enabled technologies in facilitating large-scale

inter and intra-organisational KM is of critical importance in organisations (Alavi &

Leidner, 2001).

In the new healthcare services provision paradigm, the appropriate sharing and usage of

knowledge is essential in sustaining economic vitality and growth. Subsequently, IT tools

are also considered to be central to the necessary transformation in today’s rapidly

changing public healthcare environment (Lorenzi & Riley, 2003). These IT tools are set

to play an increasingly crucial role in enabling KM through increased access,

collaboration and communication (Southwest Educational Development Laboratory

(SEDL) Report, 2001; Mantzana & Themistocleous, 2004). A growing number of

8

policymakers, healthcare providers and consumers believe that judiciously collected and

effectively communicated web-based information allow healthcare professionals to

provide better care (Conte, 1999). Effectively applied, IT consequently has the immense

potential of improving the way healthcare professionals do their work just as the steam

engine had in the industrial revolution (Espinosa, 1998).

One such advanced web-enabled IT tool that is rapidly transforming the ways in which

organisations strategically manage knowledge today is the Intranet (Edenius &

Borgerson, 2003; Kumar, 1998). Broadly defined, an Intranet is a web-based network that

exploits the widely available and deployed standards of the Internet for internal use

within an organisation (Kalakota & Whinston, 1997). Cohen (1998) describes the Intranet

as the ‘killer application’ for KM. Edenius & Borgerson (2003) point out that studies on

the Intranet as a KM tool have focused on how employees use the Intranet to generate,

transmit, store and integrate knowledge (For similar conclusions see Venkatesh & Speier,

2000; McInerney, 1999; Miller et al., 1998; Davenport & Pealsson, 1998; Rao &

Sprague, 1998). Its usage across different business sectors is driven by a need to

overcome the limitations imposed by conventional communication methods. Lamb &

Davidson (2005) suggest that the extensive adoption of the Intranet in organisations has

been built on cumulative changes and development in the organisational and

technological context that are part of wider shifts in an emerging knowledge society. In

this context, according to Lindvall et al. (2002), the usage of IT tools such as the Intranet

is not an option but a necessity due to the amount and dynamic evolution of knowledge

that has to be captured, stored and shared.

9

Intranets are able to provide cost-effective, content rich and easy to use information

accessible on any computer platform. Through the use of web technology, the Intranet

eliminates the cost of printing and distributing corporate information such as procedure

manuals, forms and training material. Information can instead be made available

electronically and be easily updated creating a new corporate-wide knowledge base. In

addition, the open platform feature of the Intranet makes it possible for any employee to

view and access the same electronic information on a single system thereby enabling

required information to be efficiently found wherever it resides (Cortese, 1997).

Researchers have noted a number of fundamental characteristics that may make Intranet

technology appealing to potential public sector adopters. Phelps & Mok (1999) regard the

platform independent feature of the Intranet as allowing fast and up-to-date information

access and broad coverage of information to more people. Welch & Pandey (2005) see

the possibility of implementing the Intranet both locally and centrally as a feature that

gives it a highly distributed and potentially multifaceted character. Public organisations

are therefore able to improve communication and collaboration among employees, and

other key stakeholders, thus increasing productivity and providing significant savings in

time and money (Kumar, 1997). Stenmark (2000) adds that Intranets are particularly

suitable for supporting and facilitating corporate creativity and knowledge creation in

organisations. The Intranet is therefore viewed as having immense potential for the

effective facilitation of KM activities, including knowledge sharing (Newell et al., 1999).

10

The transformational ability and implications of the usage of the Intranet to facilitate KM

in the public healthcare sector is of vital importance, particularly in hospitals that rely

heavily on documentation (Welch & Pandey, 2005). In the healthcare industry that relies

heavily on documentation the Intranet has immense implications. Lohman (1999)

explains that the Intranet has the potential to open up entirely new paths of

communication and transactions in healthcare and foster radically new business patterns

and organisational configurations. The Intranet can act as a gateway to organisational

knowledge in large complex organisations such as hospitals. This encourages the sharing

of critical information and enhancing the knowledge of the user (Conte, 1999). The

Intranet can enhance the sharing of resources and also help users to overcome many of

the problems of communication and collaboration associated with distance, time and

technical incompatibility (Mann, 2005; Gottschalk, 2000; Ruggles, 1998; Bertin, 1997).

This is achieved through the relatively inexpensive Intranet setup costs, its versatility by

supporting multiple IT platform environments, its scalability in enabling the addition of

many users and work processes at high performance levels and reliable security.

Through the provision of enhanced access, sharing, creation and storage of critical

information a public hospital could be transformed into an adaptable organisation where

healthcare professionals and facilities are linked together and have quick access to the

best available evidence to support decision making. The usage of the Intranet for

knowledge sharing thus potentially enables significant enhancements in a public hospital.

These include a more participatory and collaborative work environment, the reduction of

costs and bureaucracy, the refocusing of the limited time of healthcare professionals to

11

the core value activities of healthcare delivery, spending more time with patients, training

and education.

These exciting possibilities as Telleen (1996) points out are the result of a shift in

perspective. A change from the industrial revolution as the golden age of individualism to

the information revolution as the golden age of community development and nurturing of

individual knowledge. In the latter, users are viewed as the key element, not as versatile

machines, but as important repositories of unique knowledge that could be shared and

blended via an IT tool such as the Intranet. According to Mantzana & Themistocleous

(2005), the Intranet can therefore no longer be perceived as just a support tool, but rather

as a strategic necessity for the development of an integrated IT infrastructure that can

significantly improve healthcare services and inevitably save lives.

1.2 The Research Problem

Despite these numerous potential benefits outlined, the positive impact and the promise

that IT tools such as the Intranet hold in supporting KM as highlighted in popular media

and practitioner literature, many research studies reveal rather disappointing results

(Damsgaard & Scheepers, 2001). These include reports of poor Intranet utilisation,

information hoarding (Newell et al., 2001) and the contention that IT tools such as the

Intranet actually hinder KM activities such as knowledge sharing within the organisation

by reinforcing existing functional barriers in the organisation (Hislop 2002; Newell et al.,

2001; Newell et al., 2002; Newell et al., 2003). Other researchers suggest that the effects

of IT are not universally positive (Yakhlef, 2005; DeSanctis & Monge, 1999). However,

12

many researchers (and practitioners alike) contend that IT has a major role to play in KM

(see Alavi & Tiwana, 2003; Alavi & Leidner, 2001; Isakowitz et al., 1998; Ruggles,

1998; Scott, 1998; Boland et al., 1994). This has given rise to a debate as to the role,

usage and impact of these tools (Snis & Svensson, 2004; Little, 2002).

Public hospitals in Australia have been viewed as going through what some have labelled

a ‘crisis’ (Fett, 2000) due to a variety of reasons. These include the under-funding of the

public health system, high staff turnover rates, the shortage of healthcare professionals

(e.g. nurses), employee attrition, long waiting times for patients, lack of beds, improper

documentation and a large number of adverse events (medical errors) caused by system

problems (Kankhar, 2006; Wilson, 1997; Australian Council for Safety and Quality in

Health Care Report, 2001; Runciman, 2001). Additionally, there is the common

realisation that large organisations can become so complex that required knowledge is

fragmented, difficult to locate and share, easily redundant, inconsistent or not accessed at

all. Large public hospitals in particular can be characterised by ambiguous goals or

conflicts over clear goals, professional autonomy, political interference, the need to

respond to the various needs and demands of multifarious stakeholders (e.g. patients,

employees, the community), government policy changes and continuous development in

medical, clinical and patient care practices (Van Beveren, 2003). In addition, the critical

and emergent nature of the work carried out in a public hospital, its richness and messy

character (Berg, 1998) and the continual uncertainty generated in such a context

(Atkinson, 1995) make KM of critical importance.

13

Additionally, there has been a dearth of research studies on Intranet usage in supporting

KM in the public sector, particularly in the public healthcare sector. This renders the

research conducted in this thesis as pertinent and timely. The conflicting reports on the

role and impact of IT tools in supporting KM in general and the importance of enabling

organisational conditions that could affect the usage and impact of the Intranet suggest a

need for further investigation. The scope of this research will therefore be to investigate

the role and usage of the Intranet for KM in a large public hospital, particularly its impact

on knowledge sharing. The knowledge sharing process is also examined using Nonaka &

Takeuchi’s (1995) knowledge conversion model (discussed in detail in the following

literature review chapter).

It is widely accepted that IT tools such as the Intranet are a necessary, but not sufficient

condition for effective KM. IT alone will not make a person with expertise share it with

others. The mere presence of technology will not create a learning organisation, a

meritocracy, or a knowledge-creating organisation (Davenport & Prusak, 2000). Key

enabling organisational conditions such as culture and structure are identified in the

literature as crucial mediating factors in the effective usage of IT (Snis & Svensson,

2004; Stenmark, 2003; Bansal, 2001; Damsgaard & Scheepers, 2001; Jarvenpaa &

Staples, 2000). This means that where the Intranet is used in an organisational context its

success or failure is dependent on the organisational conditions surrounding its usage (Al-

Gharbi & Alturki, 2001). It is therefore equally important to investigate the organisational

conditions that could influence the usage of the Intranet for knowledge sharing. This

14

research will additionally investigate and identify the factors that facilitate or impede the

positive impact of the Intranet in the public hospital.

This research offers a synthesis of contemporary themes drawn principally from several

bodies of literature including IT and management, which constitute the two key voices

that can be heard in the literature on KM (Raub & Ruling, 2001). The other areas

informing this research include public sector management and health/medical

informatics, a discipline that deals with the systematic processing of data, information

and knowledge and provides information on the usage of IT in the healthcare sector

(Haux, 2006; Van der lei, 2002) .

1.3 Significance of the Research

State who, besides yourself, your immediate family, and close friends, cares that this

research is done or not done Simon & Francis (2001)

This study is relevant for the following reasons:

From a theoretical perspective, in comparison to other areas of organisational research,

the research into KM systems and tools in organisations, is still in its infancy (Gallupe,

2001). Various researchers have also called for studies to investigate IT usage for KM.

Bacon & Fitzgerald (1999) for example point out that an investigation into how IT might

support knowledge is important. Alavi (2000) also maintains that while conceptual

literature on organisational knowledge and KM processes abounds, empirical and

systematic investigations of these processes and the tools that enable them are scant.

15

Markus & Robey (1988) state that there is a need for a principled debate on the

possibilities for and the limitations of IT support for KM in organisations while Galliers

(1999) declares that the present literature on KM and KM systems fail to address the role

of IT usage for KM processes in organisations. Sorenson & Kakihara (2002) add that the

literature concerning the potential types of technological support for KM is either vague

or it discusses in great detail system features only. This research thus addresses the gap in

the literature by providing a greater understanding of the role, usage, and impact of the

Intranet on the knowledge sharing processes in a public hospital. It is also a response to

Gallupe's (2001), Alavi’s (2000) and Alavi & Leidner’s (2001) call for further research

into the tools and technologies that facilitate KM.

It is increasingly evident and accepted in the extant literature, as Davenport & Prusak

(2000) shows, that KM is not equivalent to IT. However, it is also impossible to deny the

pivotal facilitating role that IT tools play in KM (Stewart, 2001). With little research

conducted on IT support for KM (Gottschalk, 2000), the results of this study aim to

positively add to the ongoing debate on the use and level of impact of technology based

systems for KM to achieve organisational objectives in the selected organisation. Borell

et al. (2001) also explain that while there is a growing interest in advanced IT tools such

as Intranets evidenced by numerous articles in the popular media, research studies remain

scarce (Stoddart, 2001). Hence, this research narrows the gap that exists between theory

and practice by contributing to the literature on the usage and impact of IT tools such as

the Intranet. It provides a deeper understanding of the Intranet’s impact on knowledge

sharing and the surrounding facilitating or impeding conditions in the organisation.

16

Relatively little research has been performed on KM in the public sector (Syed-Ikhsan &

Rowland, 2004a; Cong & Pandya, 2003). Fewer studies still have been conducted on the

usage of IT for KM in public healthcare sector organisations such as hospitals (Van

Beveren, 2003). Haux (2006) points out that there is a need for research into such

powerful and innovative IT tools in the healthcare sector. While some researchers such as

Mantzana & Themistocleous (2005), have stressed that IT in the public healthcare sector

in general is no longer perceived as a supporting tool, but as a strategic necessity for the

development of integrated infrastructure to significantly improve healthcare services.

Other researchers (e.g. Southon, 1999) state that there is still doubt surrounding the value

of IT. This research contributes to this debate by investigating the application and usage

of IT tools such as the Intranet in a large public hospital in Australia. This research is

therefore expected to be of benefit to researchers, policy makers, administrators and

practitioners alike particularly in the public healthcare sector.

Finally, from a practice perspective, organisations continue to invest large sums of money

in IT tools such as Intranets to facilitate KM. Lindgren et al. (2001) point out that, given

the risk that many KM tools and systems fail to deliver the expected benefits, an

important task for KM research is to contribute to knowledge that will support

researchers and practitioners in their efforts towards successful implementation and usage

of such tools. It is anticipated that the findings of this research will provide insights into

how efficient and effective Intranets are for facilitating KM in a large public hospital.

The aim of this research is to provide insights to guide the implementation and usage of

the Intranet as a KM tool in addition to assessing how effective Intranets for facilitating

KM.

17

1.4 Overview of Research Structure and Aims

The primary aim of this thesis is to contribute to research by investigating the usage and

impact of the Intranet for knowledge sharing in a public hospital. It also investigates the

key factors that influence its effective usage for knowledge sharing. The secondary aim

of this thesis, being an exploratory research, involves providing a platform for Intranet

users to voice their opinions. It allows them to identify those issues, facilitators and

barriers that affect their usage of the Intranet.

The research will be an in-depth case study consisting of three separate studies

employing a combination of quantitative and qualitative methods as outlined below.

1.4.1 Phase One: Research Context and Intranet Study

This phase involved a detailed study of the nature of the Intranet used at the hospital. It

involved the gathering of background facts from strategic documents and comments from

key personnel involved in its development, implementation and administration. This

phase is used to address the following question:


The specific aims of this phase include:

a. Investigating the type, technical specifications and features of the Intranet in use

at the hospital.

b. Investigating the history and development of the Intranet at the hospital.

c. Identifying the influencing actors involved in the implementation and

administration of the Intranet at the hospital.

18

d. Investigating the goals and objectives set out for the usage of the Intranet at the

hospital.

1.4.2 Phase Two: The Questionnaire-based Study

The second phase of this research adopts a quantitative approach. In this phase a

combination of guidelines developed from the literature review, information obtained

from the first phase of the study as well the researcher’s familiarity with the phenomenon

under study are used to inform the development of an online questionnaire to address the

following question:


The specific aims of this phase include:

a. Investigating the types and sources of knowledge shared within the hospital and

via the Intranet.

b. Investigating the key mediums for knowledge sharing used in the hospital.

c. Investigating user experiences and patterns of usage of the Intranet among users

in the hospital.

d. Identifying the key factors influencing the usage of the Intranet, including user

opinions on the factors that facilitate or impede its usage.

19

1.4.3 Phase Three: The Interview-based Study

In this third phase, a qualitative method using semi-structured interviews is used for a

detailed and probing investigation of issues raised by respondents in the previous phases.

Additionally, addresses the following two questions:


This question has the following aims:

a. Investigating user opinions of knowledge and KM, particularly knowledge

sharing at the hospital.

b. Investigating the characteristics of knowledge sharing at the hospital.

c. Investigating the impact of the Intranet on the knowledge sharing processes

represented by Nonaka & Takeuchi’s (1995) knowledge conversion model.

4. What are the factors influencing the usage of the Intranet for knowledge sharing

within the hospital?

Of particular interest is the need:

a. To investigate the key difficulties impeding the usage of the Intranet at the hospital.

b. To investigate the influence of culture and structure on the usage of the Intranet for

knowledge sharing at the hospital.

20

1.5 Thesis Chapter Structure

The thesis is divided into two main sections. Part one, includes this introductory chapter

and chapters two and three which provide a review of the literature. Chapter four

describes the methodology of the thesis. Part two, includes chapters five, six and seven,

and presents the three phases of the case study, the research findings, discussion of the

research findings, research contributions, research limitations and thesis conclusions.

Following this introductory chapter, chapter two critically reviews the literature on KM

providing a theoretical framework for the thesis by exploring the link between

knowledge, KM and the process of knowledge sharing represented by Nonaka &

Takeuchi’s (1995) knowledge conversion model. It also examines the features and

characteristics of the Intranet, its usage modes, and its multi-level impact as an IT tool for

KM. The chapter subsequently examines the conflicting results of IT tools for facilitating

KM, identifying the need for further investigation into advanced multi-feature IT tools

such as the Intranet and its role in KM.

Chapter three subsequently examines the extant literature on KM in the public sector, IT

usage in the public healthcare sector and the usage of the Intranet in public hospitals. The

chapter also reviews the organisational conditions that influence the impact of IT tools on

KM in public organisations. The gaps in the literature are identified, exposing the need

for further investigation into the usage and impact of the Intranet in a public healthcare

organisation, giving rise to the purpose of this thesis. Chapter four provides an overview

of the empirical research, the choice as well as justification of the research methods used.

21

The second part of the thesis includes chapters five, six, seven and eight. Chapter five

presents the first phase of the research, the research context and a detailed investigation

of the Intranet including type and technical characteristics, history and development,

participants involved in its administration, and its various features and functions. Chapter

six presents the second phase of the research which uses an online questionnaire to

examine the usage of the Intranet within the hospital. Chapter seven presents the third

phase of the research which employs semi-structured interviews to provide a deeper

insight into the usage of the Intranet for knowledge sharing, its impact on the knowledge

conversion model and the enabling organisational conditions and impeding organisational

barriers affecting usage of the Intranet. The final chapter eight presents a summary of the

research findings and discussions. It also summarises the contributions of the thesis,

research limitations, directions for future research and the research conclusions.

1.6 Conclusion

This chapter has provided the framework for this thesis. It has outlined the background,

significance of the study, research questions and aims of the thesis, including a brief

outline of each chapter. The research is based on the research gaps identified in the next

chapter through critical review of the literature concerning the impact of IT tools in

general and in the public healthcare sector, the characteristics of the Intranet and the link

between knowledge, KM and the key processes of knowledge sharing.

22

LITERATURE REVIEW

Chapter 2-Knowledge Management and the Intranet


The purpose of this chapter is to set the background for the thesis. This literature review

begins by taking a background look at KM. The concept of knowledge, its definitions and

its various typologies are then reviewed. Thereafter the concept of KM, its different

perspectives and processes including the key KM process of knowledge sharing are

examined. A detailed look at the Intranet including its various types, technical

characteristics and features is subsequently presented. The usage of the Intranet in

organisations and its multi-level impact are also investigated. Linking the Intranet with

the knowledge sharing process, the chapter highlights the features of the Intranet that

make it suitable as a tool for supporting KM. It also summarises and discusses the various

conflicting views in the literature regarding the usage and impact of IT tools for

supporting KM. Finally, the key enabling organisational conditions that facilitate the

usage and impact of IT tools for supporting KM are presented and discussed. The

significance of this chapter and the following chapter lies in the identification of the gaps

present in the literature as well as setting the basis for the methodological approach

subsequently applied in the research.

23

2.1 KM – A Background Look

The global economy, it has been argued, is in the midst of a profound change. This

transformation is based on acceleration in the pace of innovation, an increased focus on

the leveraging of knowledge and a massive increase in its diffusion due to advancements

in IT tools. However, KM is nothing new (Hansen et al., 1999). Previous researchers

such as Ives (2005) speak of a KM presence in the earliest civilizations. From the tombs

of the King’s of ancient Egypt which contained written records of the King’s life and

accomplishments, the famous library of Alexandria in Egypt, to ancient Aboriginal cave

paintings that functioned as a means of passing knowledge on to future generations,

showing examples of different techniques and methods that helped the human race to

collect, save and distribute knowledge.

For hundreds of years, owners of family businesses have also passed their commercial

wisdom on to their children. Master craftsmen have painstakingly taught their trades to

apprentices and workers have exchanged ideas and know-how on the job (Hansen et al.,

1999). This early KM was based according to Wiig (2000:4) on: “practical needs to

know...needs for expertise and operational understanding and have been important since

the battle for survival first started”. Nonaka & Takeuchi (1995) explain the

manufacturing-based industrial society of the post-war period has evolved continuously

over time and resulted in a more service based society that in recent years has been

termed the ‘information society’. In comparison to the industrial age, Nonaka & Takeuchi

(1995:28) state that: “knowledge assets are different from the capital and labour asset. It

is not finite or scarce (unlike traditional assets and inventory), it is used without being

24

consumed, the cost of acquiring knowledge is not directly related to its value in the

market”. Therefore, while the ideas that underpin KM are not fundamentally new

(Spiegler, 2000), a major implication for organisations is that it has enabled more

flexibility, as opposed to the rigidity of manufacture, capital, and labour assets which

were the focus of organisations in the industrial age (Housel & Bell, 2001). In this

modern era, knowledge has become the pre-eminent economic resource. This has

subsequently shifted the organisational focus towards the successful leveraging of

knowledge as a means to increasing individual employee and core organisational

competencies.

There is also a general recognition among researchers that the discipline of KM is a

cross-functional and multifaceted one (Lee & Choi, 2003). Gupta & Sharma (2004)

explain that over the years the evolution of KM has involved several different disciplines

and domains to become what it is today. The concept of KM can however be viewed as

developing from the resource-based view of the organisation which considers knowledge

as a key resource for achieving competitive advantage (Alavi & Leidner, 2001; Grant,

1996). This view of the firm offers a model of how organisations develop and sustain

competitive advantage (Raub & Ruling, 2001). Nonetheless, while the resource-based

view of the firm recognises the important role of knowledge in organisations, proponents

of the knowledge-based view argue that the resource-based perspective does not go far

enough. The reason being that it treats knowledge as a generic resource, rather than as

having special characteristics. It therefore does not distinguish between different types of

knowledge-based capabilities. According to Grant (1996), a key aspect of any resource

25

that provides competitive advantage is that it should be difficult to imitate or acquire.

While the resource-based view of the firm argues that resources are combined to form

capabilities that lead to competitive advantage (Grant, 1991), the knowledge-based view

of the firm argues that of all organisational resources, only knowledge can deliver

sustainable competitive advantage (Grant, 1996). Consequently, the knowledge-based

view of the firm argues that knowledge is a key resource developed from heterogeneous

knowledge bases and capabilities that add to organisational value and competitive

advantage.

According to Alavi & Leidner (2001), IT tools can play an important role in the

knowledge-based view of the firm as they can be used to synthesize, enhance, and

expedite large-scale intra- and inter-firm knowledge management. Earl (2001)

distinguishes between seven schools that are grouped into three main categories; the

technocratic, economic and behavioural. The technocratic category includes the systems,

cartographic school and process schools that are based on information technologies. They

largely support and to different degrees condition employees (or knowledge workers) in

their every-day tasks and activities. The economic category is comprised of the

commercial school which is based on explicitly creating revenue streams from the

exploitation of knowledge. The behavioural category includes organisational, spatial and

strategic schools. These are based on stimulating management to be proactive in the

creation, sharing and use of knowledge as a resource (Earl, 2001). According to Earl

(2001) each school has different themes and IT support as shown in Table 2.1 below:

26

Table 2.1: KM Categories and Potential of IT Support (adapted from Earl, 2001)

Category School

Overview and IT Contributions The Technocratic Category

The Systems School

This school is rooted in the tradition of knowledge systems and expert systems and is the longest established formal approach to KM. The main idea is to capture knowledge via databases and make it available to others who can ‘use’ the available knowledge by applying their own judgement. IT is used to capture, store, organize, and display knowledge derived from expertise and experience.

The Cartographic School

This school is concerned with mapping organisational knowledge by linking knowledge and people (e.g. ‘yellow pages’). IT tools act as gateways to making knowledgeable people accessible to others in the organisation.

The Process School

This school is seen as an outgrowth of Business Process Reengineering (BPR), and it is based on two main ideas. Firstly, business processes can be enhanced by providing operating personnel with task-relevant knowledge. Secondly, it is assumed that management processes are inherently more knowledge intensive than business processes, implying that contextual and ‘best-practice’ knowledge are important. The potential contribution of IT is the provision of shared databases across tasks, levels, and locations to workers.

The Economic Category

The Commercial School

This school is based on explicitly protecting and exploiting an organisations knowledge assets or intellectual property such as patents, copyrights or trademarks to produce revenue streams. The potential contribution of IT is the development and use of intellectual asset register and processing system.

The Behavioural Category

The Organisational School

This school is based on the use of informal intra- or inter-organisational knowledge communities to facilitate knowledge sharing and creation. The potential of IT is seen in connecting members and the pooling of their knowledge.

The Spatial School

This school centres on the use of space or spatial design to facilitate knowledge sharing. Typical examples include often used metaphors in management journals, such as the water cooler as a meeting place, the coffee bar as a ‘knowledge café’ the open-plan office as a ‘knowledge building’. IT is used to support these sociable spaces or meetings.

The Strategic School

The strategic school is essentially concerned with raising consciousness about the value creation possibilities available from recognizing knowledge as a resource. The contribution of IT is manifold and includes an eclectic mix of networks, systems, tools and knowledge repositories.

27

2.2 Defining Knowledge

To better understand the concept of KM, it is important to identify some of the

underlying components and processes. Central to this understanding of KM is the

concept of knowledge itself.

The question of defining knowledge has occupied the minds of philosophers since

classical times and has led to many debates. It would be beyond the scope of this research

to engage in a debate to probe, question or de-frame the term ‘knowledge’ or discover the

‘universal truth’ from the perspective of ancient or modern philosophy. It is however

important to consider and appreciate the different views of knowledge from the IT,

organisational theory and strategic management fields. While knowledge is viewed as a

critical factor for an organisation's survival (Edenius & Borgerson, 2003), it is difficult to

define or delimit (Alvesson, 2004). Rollo & Clarke (2001) point out that it is a complex

and elusive concept. Starbuck (1992) notes that the concept of knowledge itself is almost

as ambiguous an idea as value or importance. It has many guises and they can be defined

by conflicting epistemological and cultural categories (Jorna, 2001). The terms

‘information’ and ‘knowledge’ are also used in research and practitioner articles

interchangeably or as overlapping concepts (Hlupic et al., 2002)

Table 2.2 below provides some definitions of knowledge from various researchers.

Nonaka (1995:86) for example, defines knowledge as a justified belief that increases an

entity’s capacity for effective action. Zack (1999a:46) in a similar vein defines

knowledge as: “that which we come to believe and value based on the meaningfully

28

organized accumulation of information through experience, communication or

inference”.

Authors

Definitions of knowledge

Alavi & Leidner (2001:109)

“Knowledge is information possessed in the minds of individuals: It is

personalized information (which may or may not be new, unique,

useful or accurate), related to facts, procedures, concepts,

interpretations, ideas, observations and judgements”.

Davenport & Prusak

(2000:5)

“Knowledge is a fluid mix of framed experiences, values, contextual

information and expert insight that provides a framework for

evaluating and incorporating new experiences and information”.

Duffy (1997:30)

“Knowledge is information that is understood and when applied, adds

value to the organisation”.

Locke (1689:1) cited in

Pappas (2003)

“Knowledge is the perception of the agreement or disagreement of

two ideas”.

Nonaka & Takeuchi

(1995:86)

“Justified true belief”.

Wiig (1993)

Truths and beliefs, perspectives situation or condition and concepts,

judgements and expectations, methodologies and know-how.

Zack (1999a:46)

“That which we come to believe and value based on the meaningfully

organized accumulation of information through experience,

communication or inference”.

Table 2.2: Definitions of Knowledge

While there are different definitions of knowledge and a lack of consensus concerning the

characteristics of knowledge (Bhatt, 2001), what is common to these definitions is that

knowledge is cognitive, unique to its holder and therefore varies. As Davenport & Prusak

(2000) explain, it originates and is applied in the mind of the knower. In organisations, it

29

often becomes embedded not only in documents or repositories but also in organisational

routines, processes, practices and norms. Knowledge is unique and specific to every

situation to which it is applicable and is therefore context dependent (Bosua & Scheepers,

2002). Any understanding of knowledge must therefore accept the looseness of the

concept and thus appreciate the ambiguity of most uses of it (Alvesson, 2004).

It is also common in the literature to distinguish between aggregated data (raw facts),

information (processed data) and explicit (interpreted information) and tacit (acted upon)

knowledge types varying along a hierarchical pyramid of value (Hicks et al., 2007).

.

Figure 2.1: Hierarchical Pyramid of Data, Information, Explicit Knowledge and Tacit Knowledge

In Figure 2.1 above, each level in the hierarchy builds on the one below it, so data are

required to create information, and information is interpreted to create explicit knowledge

which is acted upon and converted to tacit knowledge. Tuomi (2000) disagrees with this

practice, proposing an inverted hierarchy and arguing that some form of knowledge must

exist before information can be formulated and data can be measured to form

INFORMATION

TACIT KNOWLEDGE

EXPLICIT KNOWLEDGE

DATA

30

information. However, Bhatt (2001:69) explains that although difficult to define

individually, the relationship between data, information and knowledge is recursive and

depends on the degree of ‘organisation’. Walters (2000) declares that knowledge is

neither data or information, despite its relation to both and the differences between these

terms are often a matter of ‘degree’

In summary, despite the different views proposed in the definitions of knowledge, they

emphasise some common themes including the personal and dynamic nature of

knowledge. They also suggest that the availability of knowledge (or access to it) may not

necessarily lead to effective action but to an increase in the potential for effective action

(Wolfe, 2007; Alavi & Leidner, 2001). While an epistemological debate on the definition

of knowledge is beyond the scope of this thesis, for the purpose of this research it is

sufficient that knowledge is viewed as an interactive process that would involve access to

and usage of information available on the Intranet. McAdam & Reid (2000) add that most

knowledge definitions and their contextual origins relate to large private organisation

studies. This research does not however aim to impose a definition of knowledge. It seeks

to provide the users of the Intranet with the opportunity to proffer their personal

perceptions and understanding of the term ‘knowledge’. This would in turn enable an

insight into and improved understanding of a practical view of knowledge.

31

2.3 Knowledge Typology

Johnston (1998) explains that attempts to develop typologies of knowledge have been a

regular component of epistemology and management (see Table 2.3 below for a summary

of some knowledge classifications). Russell (1912) (cited in Johnston, 1998) for example,

distinguishes between ‘knowledge by acquaintance’ (knowledge of someone or

something on the basis of confrontation and experience) and ‘knowledge by description’

(second-hand knowledge transferred by an individual or learnt from a document).

A common and popular typology of knowledge is the classification by Nonaka (1994),

drawing on the work of Polanyi (1962). It distinguishes between two knowledge types

existing in the organisation: namely explicit and tacit knowledge. Explicit or codified

knowledge is knowledge that is structured, can be articulated, is in formal language (e.g.

a manual) and can be shared easily and formally between individuals through the use of

IT. Tacit knowledge on the other hand is rooted in action, experience and involvement in

a specific context. It is highly personal, hard to formalise, difficult to communicate and

articulate (Nonaka et al., 1999). Ruppel & Harrington, (2000) citing Nonaka et al. (1998)

explain that it is tacit knowledge that most strongly facilitates learning, builds intellectual

capital, and adds value and competitive advantage to organisations because it is more

difficult for competitors to replicate. Alavi & Leidner (2001) citing Polanyi (1966),

however maintain that tacit knowledge forms the background necessary for assigning the

structure to develop and interpret explicit knowledge. It is therefore inaccurate to suggest

a clear distinction between the two types but rather to view them as mutually reinforcing

qualities of knowledge.

32

Inkpen & Dinur (1998) suggest that an organisation’s goal is to convert tacit to explicit

knowledge so it can be more easily shared. This sharing and communicating of

knowledge transforms individual knowledge into organisational knowledge (Robey, 1997

cited in Ruppel & Harrington, 2000). Stenmark (2002) provides an insight into other

typologies of knowledge that are evident in the literature. According to Awad (1996),

knowledge can be classified by its nature and form, its source, the way it is used, its

purpose and relevance. Foray & Lundvall (1996) propose four different types of

knowledge, based on their contexts and usage: ‘know-what’ (knowledge about facts);

‘know-why’ (explanatory/scientific knowledge of principles and laws of nature); ‘know-

how’ (process knowledge or the capability to organise resources to achieve desired

outcomes) and ‘know-who’ (social knowledge of who has control of needed resources).

Boisot (1995) distinguishes between proprietary, public, personal and commonsense

knowledge. Choo (1998), building on Boisot, suggests a differentiation between tacit,

explicit and cultural knowledge. Blackler (1995), elaborating on Collins (1993), speaks of

knowledge being embodied (action-oriented and likely to be only partly explicit

knowledge), embedded (knowledge that resides in systematic routines), embrained

(abstract knowledge dependent on conceptual skills and cognitive skills), encultured

(related to the process of achieving shared understanding) and encoded (knowledge

recorded in signs and symbols, such as books, manuals, codes of practice and electronic

records).

33

Spender (1998) categorically separates knowledge into explicit, implicit, individual and

collective. Hansen et al. (1999) differentiates between causal (knowledge of why

something occurs), declarative (shared explicit understanding of concepts, categories and

descriptors) and procedural knowledge (knowledge of how something performs or

occurs). Johannessen et al. (1999) stresses the importance of relationship knowledge (the

social capabilities of a person, and the ability to draw on the expertise of specialized

groups or individuals) while Hislop (2002) however views knowledge from a ‘practice’-

based philosophy of knowledge and suggests that all knowledge has both tacit and

explicit components, which is embedded in organisational routines, practices and

contexts.

Authors

Knowledge Types

Blackler (1995)

Embodied, embedded, embrained, encultured and encoded

knowledge.

Boisot (1995) Proprietary, public, personal and commonsense knowledge.

Choo (1998) Tacit, explicit and cultural knowledge.

Hansen et al. (1999) Causal, declarative and procedural knowledge.

Hislop (2002) Tacit, explicit and embedded knowledge.

Fleck (1997) Formal, instrumentalities, informal, contingent, tacit and meta-

knowledge.

Foray & Lundvall (1996) Know-what; know-why; know-how; and know-who.

Johannessen (1999) Relationship knowledge.

Nonaka & Takeuchi (1995);

Polanyi (1962). Tacit and explicit knowledge.

Russell (1912) Knowledge by acquaintance and knowledge by description

Spender (1998) Explicit, implicit, individual and collective.

Sveiby (1997) Competence, internal structure and external structure.

Table 2.3: Knowledge Types (adapted and modified from Heron, 2001; Stenmark, 2002).

34

The lack of a commonly accepted definition of knowledge and various knowledge

typologies are some of the reasons for the confusion still surrounding this evolving field

of KM. An appreciation and understanding of these knowledge definitions and types is

important. It informs the understanding of the usage and impact of the Intranet in the

sharing of different knowledge types.

2.4 Defining KM

KM can be viewed as the result of many historical and ongoing developments that have

helped it evolve as a field of research and study. Despite the broad interest that KM has

received from both academics and practitioners, no commonly accepted definition of KM

has emerged. Simply defined, KM refers to identifying and leveraging knowledge in an

organisation to help it compete (von Krogh, 1998). However, the term ‘KM’ is itself

subject to debate with claims that it is inaccurately labelled or suffering from a high

degree of ‘terminological ambiguity’ (Hildreth & Kimble, 2002). It has been suggested

that knowledge cannot be truly ‘managed’ in a similar manner to traditional resources

such as raw materials, land and labour (Drucker, 1993). Others contend that only the

context within which knowledge resides can be truly managed as knowledge is too

complex, slippery and ambiguous (Alvesson, 2004). KM therefore becomes contradictio

in termini or a contradiction in terms. While interesting, a detailed discussion of these

views would be outside the scope of this research.

What is important to note however, is the relevance of KM in an increasingly globalised,

complex and competitive environment characterised by rapid development in the field of

35

IT, and ensuing changes in political and economic structures (McKern, 1996). In their

review of the literature, Alavi & Leidner (2001) conclude that KM can be largely

regarded as an organisational process comprised of a minimum of four basic KM

processes: knowledge creation, knowledge storing/retrieving, knowledge sharing, and

knowledge use. These processes will be reviewed in the following sections. However, in

preparation for this discussion some perspectives of knowledge itself are examined.

2.5 Knowledge Perspectives

According to Alavi & Leidner (2001), knowledge can also be viewed from several

perspectives: (1) a state of mind, (2) an object, (3) a process, (4) a condition of having

access to information or (5) a capability. The first perspective of knowledge as a state of

mind enables individuals to expand their personal knowledge and apply it to the

organisations needs. The second perspective views knowledge as an object, something

that can be stored and manipulated (Carlsson et al., 1996; Zack, 1999a). The third

perspective views knowledge as a fluid, organic process and focuses on its sharing and

application. The fourth perspective, which views knowledge as a condition of access to

information, requires organisational knowledge to be organised so as to facilitate access

to and retrieval of content. The last perspective views knowledge as a capability with the

potential for influencing future actions (Carlsson et al., 1996). Saito et al. (2007) suggest

that these different approaches to KM reflect the distinct perspectives, conceptualizations,

and methodologies that emerge from particular disciplinary backgrounds, specific

interpretations of what knowledge is and how it can be managed, and the varied

backgrounds of those involved in KM.

36

These different views of knowledge lead to different perceptions of KM (Carlsson et al.,

1996). Accordingly, if knowledge is viewed as an object or is equated with information

access, then KM should focus on building and managing knowledge stocks. The view of

knowledge as a capability suggests a KM perspective centred on building core

competencies, understanding the strategic advantage of knowledge and creating

intellectual capital. If knowledge is viewed as a process, then KM should focus on

knowledge flow and the processes of creation, sharing and distribution of knowledge

(Alavi & Leidner, 2001). According to Saito et al. (2007), the most common approaches

to KM seem to be technology-oriented; they emphasize the explicit nature of knowledge,

and tend to interpret it as an object that can be stored in repositories, manipulated and

transferred via information and communication technologies. People-oriented

approaches, on the other hand, emphasize the tacit nature of knowledge, and tend to

interpret it as a social, context-dependent process of understanding that requires human

communication and cognition in order to emerge.

2.6 KM Processes

As stated previously earlier in section 2.4, KM in organisations according to Alavi &

Leidner (2001) can be divided into four main processes, including: (1) knowledge

creation, (2) knowledge storage/retrieval, (3) knowledge transfer/sharing and (4)

knowledge application.

Organisational knowledge creation involves developing new content or replacing existing

content with the organisation’s tacit and explicit knowledge. Knowledge storage/retrieval

37

includes the storage, organisation and retrieval of organisational knowledge. Knowledge

transfer/sharing is the transfer of knowledge to locations where it is needed and can be

used. Knowledge application involves the integration of knowledge to create

organisational capabilities (Alavi & Leidner, 2001).

This research while acknowledging the importance of all four processes will be focusing

on knowledge sharing. Knowledge to be of value and benefit needs to be shared as its

intangible nature actually grows when shared (Sveiby, 2001). In addition, organisations

often do not know what they ‘know’ and have weak systems for locating and retrieving

knowledge that resides within them (Huber, 1991). According to Alavi & Leidner (2001),

IT can play an important role in the knowledge-based view of the firm, in that

information systems can be used to synthesize, enhance, and expedite large-scale intra-

and inter-firm knowledge management. Such tools, the authors point out, would enable

exposure to greater amounts of online organisational information and support individual

learning.

Crucial to the knowledge sharing process is Nonaka & Takeuchi’s (1995) knowledge

conversion model (also referred to as the knowledge creation model and the knowledge

transformation matrix). Nonaka & Takeuchi (1995) in their extension of the

epistemological dimensions of knowledge introduced knowledge ‘conversion’ as the key

to knowledge sharing. Tacit and explicit knowledge are not viewed as separate, but rather

as mutually complimentary entities. Knowledge is viewed as created through the social

interaction of tacit and explicit knowledge. Dixon (2000) in a study on various

38

organisations points out that the two main KM processes that need to be balanced are

knowledge creation and the sharing of knowledge across time and space. Teece (2000)

also points out that the processes of knowledge creation or transfer would benefit

companies more than knowledge itself because knowledge is not primarily about facts

but more about context-specific characteristics.

Alavi & Leidner (2001) suggest that considering the flexibility of modern IT tools such

as the Intranet with its collaboration, coordination and communication features can better

facilitate knowledge sharing in the organisation. This research therefore examines the

impact of the Intranet on knowledge sharing using the knowledge conversion model of

Nonaka & Takeuchi (1995). This model represents the continual interplay or spiral flow

between the tacit and explicit dimensions of knowledge. It identifies four interdependent

modes of socialisation, externalisation, combination and internalisation which are

discussed in the following section.

2.6.1 The Knowledge Conversion Model

In their often-referenced work on innovation and knowledge creation, Nonaka &

Takeuchi (1995) Knowledge conversion model was developed from research within a

number of Japanese companies to explain the use of metaphor, language, analogy and

model-building in allowing individuals to externalize and share their knowledge with

other employees. The authors posit that organisational knowledge is created through a

continuous and dynamic interpersonal interaction between two types of knowledge, tacit

and explicit knowledge. Drawing from case studies on organisations such as Canon,

39

Honda and NEC, the authors illustrate that individual knowledge is organisationally

amplified and elevated to higher ontological levels through a process referred to as the

‘knowledge spiral’. This spiral involves activities such as the sharing of experiences,

explicating models and metaphors, exchanging and combining explicit knowledge and

embodying by learning-by-doing. These activities are usually performed by groups of

people joined by a shared set of practices.

The knowledge conversion model (Nonaka & Takeuchi, 1995) distinguishes between

four modes of knowledge sharing (see Figure 2.2 below). As Rollo & Clarke (2001)

explain, these four inter-related processes identify how knowledge is shared around the

organisation and transmutes into different forms.

Figure 2.2: Knowledge Conversion Model

Combination

• Merging, categorizing,reclassifying and synthessing existing explici knowledge

• Example: Survey reports

Externalisation

Converting tacit knowledge to new explicit knowledge

• Examples: Activities Dialog within a team, answering questions.

Internalisation

• Creation of new tacit knowledgeFrom explicit knowledge

• Example: learning that results from

Socialisation

•Exchange of tacit knowledge

through sharing experiences

• Example: Apprenticeship

•

• reading or discussion

40

Socialisation (tacit to tacit mode): is the exchange of tacit knowledge among members

that create common mental models and abilities. Socialisation transfers tacit knowledge

most frequently through the medium of shared experience (e.g. apprenticeship).

Externalisation (tacit to explicit mode): is the process of articulating tacit knowledge and

transforming it into models, concepts, analogies, stories and metaphors that can be

communicated by language. Externalisation is considered to be a key phase in the

creation of new knowledge and is triggered by dialogue, collective reflection and writing.

Combination (explicit to explicit mode): is the process of combining or reconfiguring

bodies of existing explicit knowledge in order to generate new explicit knowledge,

through addition. It is the most common process in formal education. In organisations, it

is obtained by the exchange of explicit knowledge among members (e.g. project reports).

Internalisation (explicit to tacit mode): is the process of adding to explicit knowledge

(principles, procedures and methodologies) new tacit knowledge (in the form of

sensations, memories and images) through experimenting in various ways, such as real

life experience, simulation of limit situations or simulation through the usage of software.

The knowledge conversion model has however also come under criticism by researchers.

Some of the criticism surrounding the usage of this model has included suggestions that

the model is not broad enough (Stenmark, 2003). Nonaka & Takeuchi (1995) studied

manufacturing companies in Japan where it has been argued that its cultural context is

41

one where tacit knowledge is traditionally valued and the results might therefore not be

readily generalisable in organisations in the western world.

Others such as McAdam & McCreedy (1999) describe knowledge sharing in an

organisation as much more complicated and convoluted than the model suggests.

Firestone & McElroy (2003) also point out that it oversimplifies the process of

knowledge sharing as the processes mentioned in the model include more than clearly

defined starting states of explicit or tacit knowledge from which to begin and end. For

example this is highlighted in the process of combination which is viewed as the

conversion of ‘explicit’ knowledge to ‘explicit’ knowledge. When two or more people

come together to combine ‘explicit’ knowledge to create new ‘explicit’ knowledge, they

bring not only ‘explicit’ but also tacit knowledge to the process of combination. In later

works on the knowledge conversion model, an enabling ‘context’ or ‘knowledge space’

referred to as ‘ba’ is added and considered important in facilitating knowledge sharing by

adding more depth to the model (see Von Krogh et al., 2000; Nonaka & Nishiguchi,

2001).

Nevertheless the knowledge conversion model continues to hold strong appeal among

researchers and practitioners as being a well documented and widely used approach

across several areas of research such as organisational learning and studies investigating

the usage of IT (Scott, 1998; Scharmer, 2000). The knowledge conversion model is

therefore considered sufficient for the purposes of this research to investigate the usage

and impact of the Intranet.

42

In summary, this section provided a background to KM. In reviewing KM, it also

investigated the concept of knowledge, knowledge typologies and perspectives as well as

KM processes in particular the key KM process of knowledge sharing as depicted by

Nonaka & Takeuchi’s (1995) knowledge conversion model. The following section will

examine the Intranet in detail including its different types and characteristics, diverse

features, variety of usage and multilevel impact in organisations. Furthermore, the section

examines the link between the Intranet as an IT tool and the facilitating of KM, in

particular knowledge sharing. It also investigates the nature of the conflicting results

from the usage of IT tools.

2.7 The Intranet

I think there is a world market for maybe five computers.

Thomas J. Watson, Chairman of IBM in 1943 (cited in Schultes, 2004)

A profound statement by the then chairman of what is today the world’s largest computer

hardware organisation. The impact of computer technology and its many manifestations

is evident in almost every household in both the developed and developing worlds. There

are now supposedly over hundreds of millions of computers in the world and that figure

is growing at an exponential rate.

The successful adoption and usage of IT (a manifestation of computer technology) in its

different forms creates a competitive ‘differentiator’ for organisations (Ruikar et al.,

2005) operating in today’s work environment characterized by radical discontinuous

43

change (Malhotra, 2005). The term IT generally refers to computer and computer-related

technology applications and mechanisms that promote access to, and utilisation of a

variety of digitised text and data resources. Previous research highlight the impact of IT

on organisational transformation. According to Robey & Azevedo (1994), in these

arguments, IT is typically cast in the role of enabler, supporting faster and more accurate

flows of information and overcoming the constraints of time and place. The prospect of

using new technologies to achieve greater organizational effectiveness has always

attracted interest because organizations have such pervasive impacts on the quality of

worklife and upon social and economic well-being.

Importantly, knowledge is of limited organisational value if it cannot be shared. Hence,

IT tools are viewed as a potential vehicle through which knowledge can be shared

(Alavi& Leidner, 2001; SEDL Report, 2001). IT tools have therefore emerged as a key

enabler of communication, collaboration and relationship building among individuals,

workgroups, across functions and geographical locations in many organisations.

To be successful, an organisation must be able to quickly access and incorporate

knowledge from internal and external sources to adapt and innovate faster, reduce costs

and increase performance. IT tools in this regard are associated with a variety of benefits

(Hendricks & Vriens, 1999) including increasing the availability of expertise and

retention of knowledge even after the departure of an expert. They can be used for

increasing the cognitive capabilities of users through online training programs. They can

improve the consistency of decisions by providing needed information quickly regardless

44

of physical location and provide the building blocks for the organisation’s ‘memory’ by

creating knowledge bases where knowledge can be stored for later access. One such IT

tool that is often used to support knowledge sharing within organisations is the Intranet

(Ruggles, 1998).

2.7.1 Defining the Intranet

The growth and ubiquity of the Internet, an open, global network that allows information

services to be accessed regardless of location and time has enabled novel ways of

accessing, sharing and delivering information services and products (Lamb & Davidson,

2005; Lyytinen et al., 1998). This has also led to the development of advanced IT tools

like the Intranet based on the Internet networked architecture and standards, allowing

end-users to make use of sophisticated web-based communication and collaborative

applications. The term ‘Intranet’ was reportedly coined by Eric Schmidt, the Vice

President for technology at Sun Microsystems, to describe the application of Internet

standards and systems to the management of internal corporate networks (Regli, 1997).

According to Damsgaard & Scheepers (1999), An Intranet (see Figure 2.3 below for a

conceptual view) is broadly defined as the application of web-based technology within an

organisational boundary.

45

Figure 2.3: Conceptual view of the relationship between the Internet and Organisational Intranet

Kalakota & Whinston (1997) view it as a web-based network that exploits the broadly

available and deployed standards of the Internet for internal use within an organisation.

According to Phelps & Mok (1999) a typical Intranet uses all the elements of the Internet,

but is internally focused and has no public internet backbone. As Figure 2.3 shows,

access is generally restricted exclusively to organisational members by means of a

firewall or software/hardware that allows users to access a protected network. All these

definitions show, as Curry & Stancich (2000) describe, that Intranets are private

computing networks, internal to an organisation and allowing access only to authorised

users. Much like the Internet, the major components of an Intranet include: a web server,

a browser, telecommunication transmissions standards, page displays in HyperText

Markup Language (HTML), a search engine, and a secure firewall against external

incursion (Newell et al., 2001; Welch & Pandey, 2003).

The InternetOrganisational

Intranet

Firewall

46

A key characteristic of the Intranet is its use of the open standards and protocols of

Internet technology to seamlessly link different corporate resources (i.e. databases and

other existing information systems) and integrates them into a common, unified internal

information structure that is accessible across all platforms. Generally, all members of the

organisation would have access to the Intranet. The Intranet can be run on multiple

hardware platforms enabling the exchange of information across otherwise incompatible

networks. Intranets can also utilise other Internet protocols like SMTP (Simple Mail

Transfer Protocol) for E-mail, HTML (HyperText Markup Language) for web publishing

and browsing and HTTP (HyperText Transfer Protocol) for communication between

browsers and servers, both internally and externally over the Internet. This enables the

sharing of information, the creation of documentation and shared workgroup applications

on the Intranet.

Intranets are said to evolve, not in a controlled and planned way, as with other major IT

project investment, but along a dynamic and evolutionary path, determined by the users

themselves, with the necessary environment and support. An Intranet can therefore be

emergent in nature and has no well-defined boundaries (Damsgaard & Scheepers, 1999).

Another characteristic of the Intranet is that there tends to be no clear distinction between

Intranet ‘developers’ and Intranet ‘users’. This is because users are able to create content

(e.g. home pages) as well as functionality (e.g. publishing links) and thus also act as

Intranet developers. The Intranet also requires the right infrastructure and dedicated

resources. It has therefore been suggested that Intranets represent a radical shift in the

nature of IT development, IT services, their delivery and associated organisational

47

processes (Lyytinen et al., 1998). Curry & Stancich (2000) state that the clear advantages

of Intranets are the reduction in duplication of information, reduction in

paper/video/audio copying and distribution costs as well as faster and direct access to

information.

Goles & Hirschheim (1997) looking at a typology of Intranets suggest four distinct types

or ‘waves’ of Intranet development in organisations:

Information publishing applications

Informal collaboration applications

Transaction-oriented applications

Formal collaboration applications

Intranet applications can include a combination of the applications highlighted. Differing

Intranet applications in organisations may also exist based on their intended uses.

Technically however, their commonalities revolve around being built using the same

basic underlying architecture and network protocols for communicating and exchanging

information that form the Internet. As Goles & Hirschheim (1997) point out, usually the

primary intended use of the Intranet is for communication and collaboration among

organisational members with users being able to publish, search and retrieve information

about diverse topics and collaborate with colleagues anywhere in the organisation. Key to

these possibilities are the technical characteristics of the Intranet discussed in the

following section.

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2.7.2 Technical Characteristics of the Intranet

The Intranet has technical characteristics that are important for understanding its

appropriateness as a tool that supports KM. The following are some of the key

characteristics identified by Damsgaard & Scheepers (1999) and Stenmark (2002):

Intranet technology is multi-purpose and richly networked. The Intranet is highly

networked as it is distributed both physically and administratively. The client/server

architecture and the Uniform Resource Locator (URL) function allows information to be

placed anywhere on the network, making the physical whereabouts of the information

transparent to the user. Intranets also differ from other traditional organisational

information systems (i.e. inventory systems and payroll systems). While these systems

perform well-defined functional tasks, the Intranet unifies and seamlessly integrates these

systems acting as an interactive medium.

Intranet technology depends on supporting technologies (i.e. TCP/IP protocols) and a

physical network infrastructure. These supporting technologies and network

infrastructure must be in place before the technical setup of the Intranet. Issues such as

the adequacy of network bandwidth (the size of the ‘pipe’ that pumps information across

the network), network accessibility and reliability are critical to the performance of the

Intranet.

The Intranet changes much of the intra-organisational information flow from a push-

based to a pull-based model. Information push is when information is broadcast to a

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passive receiver as with E-mail, which has dominated organisational information sharing,

with today’s employees used to checking their Email ‘inbox’ regularly. Information pull,

in contrast, requires the user to actively search for information. The Intranet does not

send any information to the users’ browsers unless it is requested by clicking on a

hyperlink (Stenmark, 2003).

The Intranet is hyperlinked. The Internet was initially invented to allow scientists and

researchers to communicate, collaborate, and exchange information in a transparent way.

Much of this transparency is due to the hyperlink concept. The ability to create

hyperlinks to other resources is perhaps the most significant feature of the Internet and

something that allows it to transcend printed media. The hyperlink feature provides

Intranet users with extremely easy access to a huge amount of information, available at

their fingertips. This super-connectivity aspect enables the individual as well as large

organisations to distribute information with equal ease (Turoff & Hiltz, 1998). The

hyperlink feature also makes the web inherently pull-oriented and entirely user-driven

(Damsgaard & Scheepers, 1999). Using the hyperlink feature, the user is able to request

information from the server.

The Intranet is open, flexible and robust. As Stenmark (2002) points out, the Internet is a

bottom-up technology based entirely on open and accessible standards. Like the Internet,

the open standards of the Intranet allow the use of a wide variety of computer equipment

and software for access and use. The access mechanism of the HTTP protocol enables the

development of add-ons, which in turn guarantees adaptability and access. The web

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technology also makes the Intranet malleable: in the sense that it is multi-purpose, unlike

many other information system solutions such as payroll systems (Damsgaard &

Scheepers, 1999). An Intranet therefore does not exclude the presence of other IT

systems. It is also multi-purpose and media-rich, allowing a variety of formats including

images as well as video and audio. Furthermore, information can be displayed

independently of network or server topology. This makes an Intranet a very flexible IT

tool (Scott, 1998).

2.7.3 Intranet Usage in Organisations

Intranet technology can be applied in different ‘use modes’ simultaneously (Damsgaard

& Scheepers, 2000). These range from simple use modes such as publishing, to more

advanced use modes such as interacting between individuals, recording information,

organisational-wide searching for information; transacting on Intranet pages and

integration with other organisational computer-based information systems. The usage of

the Intranet tends to evolve and increase in sophistication over time (Damsgaard &

Scheepers, 2001; Romm & Wong, 1998). As Scheepers & Damsgaard (2001) explain,

citing (Attewell, 1992), this pattern is not imposed by the technology itself, but exhibits

the organisational learning involved in applying the technology. Summarised in Table

2.4 below is a classification of Intranet user modes.

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Publishing

Using the technology to publish information (e.g. home pages, newsletters, technical

documents and employee directories).

Transacting

Using the technology to transact with functionality on Intranet pages and other

organisational information systems (e.g. online purchase order forms).

Interacting

Using the technology to interact with other individuals and groups within the

organisation (e.g. discussion groups and collaborative applications).

Searching

Using the technology to search organisational information (e.g. search engines,

indexes and agents).

Recording

Using the technology to record computer-based organisational memory (e.g. best

practices, business processes and frequently asked questions).

Table 2.4: Intranet User Modes (Adapted from Damsgaard & Scheepers, 2000)

Publishing: The Intranet is used to publish information (Romm & Wong, 1998) enabling

a treasury of corporate knowledge to be shared and made widely accessible. Using links

to documents and websites, the Intranet has the ability to render or publish documents in

alternative formats including HTML, Portable Document Format (PDF) and eXtensible

Markup Language (XML).

Transacting: The Intranet is used to transact with functionality on Intranet pages and

other organisational computer-based information systems by automating and integrating

mission-critical business processes with key stakeholders via online forms (Damsgaard &

Scheepers, 2001; Ressler & Trefzger, 1997). For example online purchasing systems for

procurement and forms for human resource (HR) related requests. Costs associated with

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generating orders or particular requests can be significantly reduced, broad access can be

provided to multiple users, time saved and an audit trail of the process made possible.

Interacting: The Intranet provides services that can connect users and experts and support

interactive features such as instant messaging, web-based E-mail, chat tools, discussion

forums and bulletin boards, whiteboards, and application sharing essential for

collaboration (Damsgaard & Scheepers, 2001; Jarvenpaa & Ives, 1996). The Intranet is

able to leverage the knowledge from internal knowledge sources within the organisation

to enable knowledge sharing. For example, employees constantly work on projects that

require close teamwork. Using the Intranet as a communication and collaboration forum

allows groups to work closely. It improves knowledge sharing by having the captured

project information available and shared through threaded discussions. Team members

are able to view the projects both in the context of the rest of their information assets and

in terms of the larger communities of which they are a part. This helps to improve

employee productivity and supports project completion.

Searching: The Intranet is used to search for organisational information (Damsgaard &

Scheepers, 2001; Bhattacherjee, 1998). It has the ability to manually or automatically

index information. This includes content and context from disparate data sources such as

file serves, databases, groupware systems, document repositories and the web. Searching

can be performed by methods such as user or administrator-initiated searches, web

crawling, site/directory monitoring, and full text indexing of metadata and taxonomies.

This also makes it possible to track usage, modifications and updates.

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Recording: The Intranet can be used to store and record knowledge in the form of best

practices, business processes, and frequently asked questions which form an integral part

of the organisational ‘memory’ (Damsgaard & Scheepers, 2001; Huber, 1991).

Experience and know-how can be captured in an electronic format that can be categorised

and made available to users. Knowledge repositories can be developed on the Intranet

which would enable sharing of lessons learned from past experiences so that employees

can repeat successful tasks, avoid the duplication of efforts and the repeating of mistakes.

2.7.4 Multi-level Impact of the Intranet

The Oxford Dictionary of Current English (1996) defines impact as a ‘strong effect’. The

effect of the Intranet can be seen to occur at three different levels within the organisation;

namely the individual, group and organisational levels.

2.7.4.1 Individual Level

At the individual level, the Intranet transforms the user’s computer from a personal

productivity and communications tool, to a knowledge hub for retrieving, processing and

sharing knowledge. Some of the individual benefits include:

Providing opportunities to work in ways to suit individual preferences with choice

limited only by the need for co-operation and co-ordination.

Increased social interaction through the organisation of work.

Providing increased opportunities for self-development, particularly through

opportunities for learning and problem solving.

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Making work more satisfying.

The Intranet has also been referred to as the: “great equalizer” (Bertin, 1997:62) as it

allows other ‘voices’ to be heard in organisations where people have been previously

excluded in the traditional communication media thus leading to greater employee

involvement. The key advantage of an Intranet is the ability to get valuable information

into the hands of employees who need it the most, when they need it, so they can make

quicker and better decisions. In this manner the Intranet through increased sharing of this

valuable information allows an organisation to better align and integrate employee

knowledge and applications with its strategic business goals and objectives.

2.7.4.2 Group Level

At the group level the Intranet affects knowledge sharing within and between different

groups of individuals. Highly knowledgeable cross-functional work groups can be

brought together with direct access to the most intelligent internal and external business

networks. The Intranet’s collaborative features (i.e. threaded discussions, live chat and

instant messaging) allow group members to communicate and collaborate closely and

seamlessly on a specific task, increasing awareness of other employees and the

organisation (Begbie & Chudry, 2002). Curry & Stancich (2000) explain that some

organisations use the Intranet at the group level to facilitate collaboration along the value

chain; thereby enabling the reduction in errors in project design, data entry and

manufacturing. This ensures faster agreement on issues and faster time to market.

Schachtman (1998) also suggests employees are using Intranets to work across traditional

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corporate structures. Informal groups are increasingly able to be formed as a result of

common interests than as predetermined task-oriented groups, otherwise referred to as

communities of interest.

2.7.4.3 Organisational Level

At the organisational level, the Intranet provides the opportunity to define the

organisation, with the ability to present its vision, guiding values, strategic goals and

objectives to its employees. The Intranet can lead to the transformation of the

organisation (Yakhlef, 2005) by permitting new work arrangements through the shrinking

of time and space constraints (Snis & Svensson, 2004; Wigand et al., 1997; Morton,

1991; Sproull & Kiesler, 1991). This allows organisations to cut costs associated with

coordinating dispersed geographical facilities (Scacchi & Noll, 1997; McNaughton et al.,

1999; Damsgaard & Scheepers, 2001).

An Intranet is also able to present a common organisational view to its users in addition

to showing a single shared view of the entire collection of corporate documents. The

Intranet allows a common explicit (e.g. taxonomies and category systems) or implicit

(e.g. clusters and patterns) interpretative schema of corporate knowledge to be created

(Bonifacio et al., 2001), providing access and maintaining organisational memory

(Morton, 1991). The resulting organisation-wide knowledge sharing leads to improved

leveraging of organisational knowledge (Carayannis, 1998), allowing for a more agile

organisation with the necessary flexibility to aptly respond to changes in its environment.

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2.8 Linking the Intranet and KM

As mentioned previously in section 2.2, although there are a variety of views on KM,

they all centre on the notion that knowledge is a valuable asset that must be exploited. In

particular, the finding of ways to actively support the process of organisational

knowledge creation and sharing is an activity that should be prioritised (Stenmark, 2003).

Previous research has shown IT as a facilitating infrastructure for knowledge sharing

(Scarbrough & Swan, 1999; Sorensen & Snis, 2001; Little et al., 2002). Central to this

argument is the importance of the usage of IT tools such as the Intranet that is able to

share and provide access to knowledge (Kim & Trimi, 2007). Thus enabling powerful yet

simple-to-use applications to stimulate creativity, increase efficiency and effectiveness

(Nonaka & Takeuchi, 1995; Milton et al., 1999; Stenmark, 2003).

Advances in IT have better facilitated the effectiveness and subsequently, the impact of

IT tools that are able to support KM. The Intranet with its wide spectrum of features that

allow for user communication, coordination and collaboration is referred to as a

‘knowledge technology’ (Alavi & Leidner, 2001; Carvalho & Ferreira, 2001; Damsgaard

& Scheepers, 2001; Newell et al., 2001; Gottschalk, 2000). Milton et al. (1999)

emphasise that knowledge technology should have two important features: (1) it should

encompass a wide range of methods and (2) for most applications, it should be usable by

relative novices. The Intranet falls into this category due to being based on Internet

technology, which as a result allows for flexibility, scalability and ease of usage. Recent

studies (Spies et al., 2005; Gottschalk & Khandelwal, 2004) found that knowledge

technology such as Intranets play an important role in KM, facilitating improvements in

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knowledge workers day-to-day tasks. A key feature is the scalability of the Intranet which

enables easy expansion and modification while remaining equally accommodating to the

number of users and usage patterns. The Intranet can thus address an organisation’s

changing needs on an ongoing basis, increasing productivity while minimising related

costs.

Researchers such as Galliers (2000) also referred to Intranets as Knowledge Management

Systems (KMS) or systems designed and developed to give users in organizations the

knowledge they need to make their decisions and perform their tasks (Davenport, 1998).

They are able to ease the sharing, integration and leveraging of knowledge (Grant, 1996;

Quinn, 1992). They speed up the replication of best practices across time and place

(Nelson & Winter, 1982). Jensen & Meckling (1992) add that Intranets enable the

achievement of economies of scale and scope in an organisation, while Hedlund (1994)

sees them reducing the costs of searching and transforming available knowledge for local

use.

Several researchers have pointed out the significance and possibilities of the Intranet in

KM. The Intranet has been described as the ‘killer’ application for KM (Cohen, 1998)

and hailed as the ‘ultimate solution’ (Stenmark, 2003). Ruppel & Harrington (2000)

explain that it is a technology upon which many KM systems are built since it is capable

of distributing knowledge. Ruggles (1998) points out that the Intranet is often used to

support knowledge access and sharing within organisations. Newell et al. (1999) reported

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that Intranets are viewed as tools for the more efficient sharing and creation of knowledge

within organisations.

Hall (2001) adds that Intranets can be regarded as key platforms for knowledge sharing

and as tools for formalising distributed cognition. They can provide basic facilities such

as common resources for the support of personal work practices (e.g. time sheets). They

also permit the integration of key business applications and tools. Curry & Stancich

(2000) described how Intranets can encourage information sharing, information

publishing and facilitate document management. More advanced Intranets provide the

resources that encourage knowledge sharing, including internal meeting ‘places’ for

discussion groups and shared databases. In support, Edenius & Borgerson (2003) point

out that an Intranet is able to intervene and reshape knowledge via diverse modes of

representation. By representation they were referring to the symbolic codification found

in an Intranet’s operative scheme such as texts, documents or statistics. The Intranet,

instead of being a container-like tool where knowledge is imagined to reside as a kind of

stable entity or stock of fixed information, becomes a complex system of discursive

practices or texts, written reports, pictures, charts, statistics and representation in general.

It is therefore able to give meaning to the world, organise social processes, and naturalise

such structures and meanings.

Alavi & Leidner (1999) found that organisations that undertake KM initiatives most often

do so by implementing an Intranet because they allow the sharing of document-level

information and concepts, rather than the record-level information that traditional IT

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systems do (Zhang, 2000). Stenmark (2003) in agreement also points out that when

organisations adopt Intranets, they have what seems to be a good foundation for

knowledge creation. Ruppel & Harrington (2000) citing Roos & Krogh (1996) explain

that because knowledge is in the individual’s mind and must be processed and

communicated, increased knowledge may result from investments in connecting

employees through the use of the Intranet. Therefore by providing such access to

knowledge the Intranet can potentially impact the knowledge sharing process in

organisations.

According to Snis & Svensson (2004), one of the motivations they see for developing

such large scale KM systems such as the Intranet is derived from the assumption that

these systems will enable knowledge sharing processes that cut across organisational

departments and functions and thereby serve as an important tool for the establishment of

an organisational knowledge repository. Choo et al. (2000) (cited in Carvalho & Ferreira,

2001), consider Intranet technology as a turning point in the history of computing in

organisations, comparable to the PC revolution in the 1980s. Moreover, they view the

Intranet functioning as the IT infrastructure that facilitates knowledge sharing and use,

and they base their argument on Nonaka & Takeuchi’s (1995) knowledge creation model

that describes the need for both knowledge bases and communication spaces in order to

support the knowledge creation process.

Carvalho & Ferreira (2001) in their evaluation of KM-related technologies proposed a

typology of KM solutions each of which emphasised specific KM aspects. Their study

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also identified which of Nonaka & Takeuchi’s (1995) knowledge conversion model is

dominantly supported by different IT tools. In their evaluation of the standard Intranet,

they suggested it was an appropriate tool to systematise and add the explicit knowledge

that is dispersed through departments and is therefore better suited to the combination

(explicit to explicit mode) of the knowledge sharing process. The Intranet could also

represent the enabling context or the knowledge communication space referred to as ‘ba’

(Nonaka & Nishiguchi, 2001). The authors feel that the Intranet’s hypertext structure

helps this process because the navigation through links can create a new organisation of

concepts.

2.9 Usage and Impact of IT tools on KM: Why Conflicting

Results?

Despite this enduring interest in the relationship between information technology and

organizations, the variety of actual consequences for organisations has not been

satisfactorily explained (Robey & Azevedo, 1994). Zammuto et al. (2007) further

emphasize the need for an increased understanding of the impact of IT on organisational

form and function as organisations become increasingly reliant on IT.

In addition, despite the numerous potential benefits, impact and the promise that Intranet

technology holds in supporting KM as highlighted, many of the early research studies

indicate rather disappointing results and present few documented examples of success

(Damsgaards & Scheepers, 2001; Newell et al., 2001). A review of the extant literature

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on the impact of IT tools for facilitating KM organisations exposes a debate as to the

roles and impacts of these tools in knowledge sharing (Mohamed et al., 2006; Snis &

Svensson, 2004; Little, 2002; Swan et al., 1999).

Kock et al. (2000) taking a pre- and post-1990s look on the impact of general

collaborative technologies on KM also present what they considered, confusing results.

On one hand, many researchers (and practitioners alike) contend that IT has a major role

to play in KM (see for e.g. Boland et al., 1994; Isakowitz et al., 1998; Ruggles, 1998;

Scott, 1998; Turoff & Hiltz, 1998; Boisot & Griffiths, 1999; Bolisani & Scarso, 1999;

Bansler et al., 2000; Meso & Smith, 2000; Swan & Scarborough, 2001). With the

pervasive role of IT tools in most organisational KM applications, Scott (1998) for

example viewed the Intranet as the ultimate solution to many organisational issues, from

the dissemination of management vision to the integration of incompatible computer

systems in an organisation.

On the other hand, studies such as those conducted by Orlikowski (1992), Ackerman

(1994) and Riggs et al. (1996) paint a picture of the inability of these technologies to

support KM. There have been conflicting reports received of poor utilisation and

information hoarding that not only block knowledge sharing but reinforce departmental

barriers (see Newell et al., 1999; Newell et al., 2001). Many KM tools do not deliver on

the promised expectations of improvements in organisational performance (Swan et al.,

1999).

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Critics also point out that the practice of KM is frequently reduced to the implementation

of new IT systems for knowledge transfer (Alvesson, 2004). Other studies (e.g. Hislop,

2002; Newell et al., 2001; Newell et al., 2002; Newell et al., 2003) further contend that IT

tools actually hinder KM within the organisation while also helping to reinforce existing

functional and national barriers within electronic knowledge silos in the organisation.

According to Swan et al. (2001), much of the KM literature asserts that the exploitation

of knowledge can be successfully facilitated by the use of IT tools, but it may also be a

disabling influence if aspects such as social change and politics are not considered.

Sorensen & Kakihara (2002) explain that research within KM tends to lie at extremes,

either overemphasizing or underestimating the role of IT tools. Stenmark (2003) explains

that conflicting claims have emerged from scholars of the IT community (e.g. Scott,

1998) who maintain that tools such as the Intranet have far reaching impacts on the

organisation. In the field of organisational science, voices (e.g. Newell et al., 1999;

Newell et al., 2001) can be heard suggesting that IT tools are actually detrimental to KM

in organisations, encouraging fission by reinforcing existing barriers and thus preventing

knowledge sharing.

Another perspective is that the ‘types’ of knowledge created and shared makes IT usage

inappropriate. Previous research (i.e. Johannessen et al., 2001) point out that the use of IT

alone does not emphasise the basic knowledge types of explicit and tacit knowledge in

the organisation. A major factor for the unsuitability of IT tools in general for knowledge

sharing is the ‘tacit’ nature of knowledge. Tacit knowledge is personal, hard to formalise,

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difficult to communicate and articulate (Nonaka et al., 1999), it is therefore considered

problematic to share using IT tools (Haldin-Herrgard, 2000).

Results from previous research (e.g. Szulanski, 1996) empirically testing the relationship

between tacitness and the difficulty of knowledge sharing found it to be significant. The

more tacit the knowledge, the more difficult it is to share via IT. One perspective on the

reasons for these confusing results is the lack of physical and social cues in collaborative

technologies. This is problematic and affects users’ perceptions of the communication

context and interpretation of messages (Rice, 1984; Trevino et al., 1987 cited in Leh,

1999). Researchers (i.e. Nonaka & Takeuchi, 1995; Spender & Grant, 1996; Teece et al.,

1997) also add that it is tacit knowledge that will determine to what extent organisations

will be competitive in a turbulent business environment and global economy. IT has thus

been viewed as being able to focus on the sharing of explicit knowledge and considerably

lacking in effectively supporting the sharing of tacit knowledge in the organisation.

It is also contended that knowledge is best shared through self-organising autonomous

networks of people with similar interests or Communities of Practice (CoP). According to

Wenger (1999), CoP’s tend to be comprised of individuals who have worked together and

through extensive communication and interaction, have developed a common sense of

purpose and a desire to share work-related knowledge and experience. Dixon (2000)

argues that the CoP model allows organisations to overcome barriers to sharing

information that technology-based KM systems often encounter. For example, people

who are reluctant to contribute when asked to write something for a database are willing

to share information when asked informally by their colleagues (Dixon, 2000).

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However other researchers counter that new and advanced IT tools such as the Intranet

provide richer mediums of communication that are able to address the problems of

communication context and message interpretations faced by other general collaborative

IT tools (Firestone, 2003). Other researchers also point out that human-based mediums

for knowledge sharing can be very slow and may preclude wide dissemination of

knowledge in organisations (see Bhatt, 2001; Holtham & Courtney, 1998).

Damsgaard & Scheepers (2001) in their analysis of why there have been mixed results

suspect that the reason for such disappointing findings is twofold. Firstly, many Intranet

studies have focused mainly on only one popular application of the technology, namely

publication of organisational information. However, richer application modes of the

technology are available that may be more conducive to knowledge sharing are available.

Secondly, there is the fairly static view presented by some authors of Intranet technology

as a ‘given’, packaged technology with some universal characteristics and features

(Lyytinen & Damsgaard, 1998). Kling & Lamb (2000) suggest further that within the

confines of complex and dynamic organisational environments, accurate predictions

about IT effects are difficult to make. Research provides multiple examples of IT

adoption and implementation that may work in one organisational context but not

necessarily in others

Similarly, Stenmark (2003) attributes some of these conflicting views to the term

‘Intranet’. It has many associations and has been used to include technologies such as

Lotus Notes, E-mail and file sharing. Damsgaard & Scheepers (2001) present the

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argument that unlike the implementation and usage of IT in general, IT tools based

Internet-based computing architecture is fundamentally different. For general IT tools

development and usage is isolated and well defined, while Intranets and other Internet-

based applications provide a seamless unified user interface to information systems

(within and outside the organisation, and to both new and existing systems). They have

no well-defined boundaries or time span, they are not designed by experts and are

emergent in nature. Such systems are also able to comprise workflow and project support

services and integrate structured and unstructured information.

It is therefore arguable that a possible reason for the conflicting results on the impact of

IT is based on the ‘type’ of technology investigated. As Riggs et al. (1996) point out; the

current collaborative technologies lack enough maturity to effectively support KM in the

organisation. Other researchers such as Majchrzak et al. (2000) point to the need for the

technology to have certain features to be able to support effective KM. While these IT

tools are able to deal with documents in structured formats they should also be able to

handle documents in unstructured forms (e.g. paragraphs and stories). Another important

feature is that IT tools should be able to be used in an interactive and iterative manner by

the users. As Milton et al. (1999) point out, while it has also been highlighted in the

management literature, that IT is not the complete answer to the difficulties of KM

(Davenport & Prusak, 2000), it would be hard to deny that IT is an important facilitator

and can help in overcoming many of the problems associated with KM.

Although there are differences on how knowledge and information or data are obtained,

interpreted and managed, these differences do not offer a coherent rationale for alienating

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IT’s role in KM (Mohamed et al., 2006). These seemingly conflicting views on the usage

and impact of IT tools in general on KM, and in particular on knowledge sharing

however, suggest a need for further investigation. This research therefore investigates the

usage of Intranet and its impact on knowledge sharing represented by Nonaka &

Takeuchi’s (1995) knowledge conversion model.

In summary, this section presented an introduction to the Intranet, the IT tool to be

investigated, including an examination of its various characteristics, types, features,

usages and potential multi-level impact within the organisation. The section also

highlighted the features of the Intranet as pointed out in the literature that make it suitable

as a tool for supporting KM. It also examined the various conflicting views in the

literature that agree or disagree with the usage of IT tools for supporting KM. The need

was subsequently established to investigate the usage and impact of the Intranet on KM,

in particular knowledge sharing as represented by Nonaka & Takeuchi’s (1995)

knowledge conversion model. The second part of the literature review presented in the

next chapter examines the KM in the public healthcare sector in Australia, including the

usage and potentials of IT tools such as the Intranet.

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Chapter 3-The Australian Public Healthcare Sector, KM

and the Usage of the Intranet


In the second part of this literature review, an overview of the public sector organisation

and its key characteristics are presented. The implications and potentials of KM in public

sector organisations are highlighted. An overview of the Australian public healthcare

sector is discussed with a specific look at Australian public hospitals, their usage of IT

tools and the potential impact of the Intranet in such a work environment.

3.1 The Characteristics of Public Sector Organisations and KM

A public organisation may be defined by one of its key objectives, which is to provide

public services in such areas as health and education in a well-structured manner that

meets the needs of the citizens (Newcombe, 2000; Bouthillier & Shearer, 2002).

However, as pointed out in the introductory chapter, the need for cost cutting measures to

improve efficiency, the increasing demand for accountability, the competition between

public sector organisations and private sector organisations for the delivery of goods and

services has made the exploitation of knowledge a critical determinant of competitiveness

and survival for public sector organisations (Al-Hawamdeh, 2002).

This interest by the public sector in KM is additionally driven by the ongoing trend

towards New Public Management (NPM) or a progressive adaptation to accommodate

electronic business processes. This is viewed as a move away from the standardised

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bureaucratic public system to one of greater flexibility, efficiency and performance

measurement (Roste, 2006; Minouge et al., 1998). The exploitation of knowledge is thus

perceived as an invaluable asset for organisational enhancement in the public sector

(Riley, 2003). Echoing these sentiments, Gramatikov (2004:1) emphasizes that KM is of:

“the utmost importance” for reasons specific to the public sector. He goes on to explain

that: “the nature of the public policies assumes that the public organisations fulfil their

missions mainly through processing of information. The capacities of the public

organisations to collect, process and disburse information effectively are determining

how well these organisations will perform” (Gramatikov, 2004:1). The benefits of KM to

public sector organisations according to Cong & Pandya (2003), lead to improved

performances through increased efficiency, productivity, quality and innovation. It also

results in a reduction in the cost of operations and improved customer service in public

organisations.

Public sector organisations tend to have distinct characteristics (Kernaghan et al., 2000).

A particularly important characteristic is the framework within which public

organisations operate. A public organisation usually abides by a wide range of

regulations and requirements including legislative, privacy and security. They also must

provide reports on performance to multifarious stakeholders. Organisations in the public

sector are therefore largely ‘stakeholder’ dependant, as opposed to ‘shareholder’

dependant organisations in the private sector (Cong & Pandya, 2003). A stakeholder

framework for the public sector involves the general public/citizens, national, state and

local governments, other private organisations and employees. It is also important to

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recognise that the fundamentals of how the public and private sectors operate are vastly

different (Cong & Pandya, 2003). While the private sector is usually competition based,

the public sector is dependant on other factors such as service delivery, information

provision, knowledge identification, sharing and utilisation (Riege & Lindsay, 2006).

Public sector organisations are highly influenced in their operation by the political sector

(Lenk et al., 2002). They are generally large in size, with many hierarchical layers and

wide spans of control that render them relatively formal and bureaucratic. Other

characteristics of public sector organisations are the right of the general public to receive

information about the affairs including financial data related to the organisation. They

thus handle a vast amount of essential information that is required both internally and

externally. Furthermore, as researchers such as Barney (1996) and Cong & Pandya

(2003) point out, public organisations have a high rate of retirement or staff defection.

This leads to a loss of essential knowledge within the organisation coupled with already

insufficient systems for knowledge recording (Sveiby & Simons, 2002). Furthermore,

public sector organisations are often faced with budget cutbacks and a need to do more

with fewer resources leading to an increased focus on organisational knowledge (Mueller

& Dyerson, 1999).

KM it can be argued, would therefore be a key requirement for organisations in this

sector. However, as Riege & Lindsay (2006) point out, there is little evidence on the

application of KM in the public sector published in the literature. Prokopiadou et al.

(2004:170) state that: “the public sector produces and disseminates huge amounts of

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information, either concerning legislation or governmental operations or citizen-state

transactions”. The primary objective of KM in public organisations, according to

Bouthiller & Shearer (2002), should be focused on external and internal knowledge

sharing to aid decision making. Therefore, the use of IT systems in helping public

servants make decisions based on complex governing laws and regulations must be

addressed appropriately.

A review of the literature shows that historically, most management reforms and

techniques were first introduced in large private organisations with the public sector

following suit (McAdam & Reid, 2000). Examples include enterprise resource planning

(ERP), business process re-engineering (BPR) and total quality management (TQM). KM

is no exception. However, the relative currency of KM ‘awareness’ in order to reap its

promised benefits has resulted in most of the research and implementation being

conducted mainly in large private organisations (Cong & Pandya, 2003).

While the need for KM is apparent, critics argue that the differences between the sectors

are too great to simply, as Itkonen (1999) highlighted, import such managerial reforms

from the private sector. Straight forward emulation is therefore difficult (Cong & Pandya,

2003). Significant differences exist among others in primary goals and objectives, HR

policies and practices, in the management of ethical issues as well as decision making

processes. An OECD & Puma survey conducted in 2003 investigating KM practices in

ministries, departments and agencies of central governments stressed that: “the incentives

to lower costs are traditionally less important in central public organisations” (p. 9). The

survey also noted that public organisations and processes are designed in such a way that

71

makes changes more difficult to implement (OECD & Puma survey report, 2003).

Additionally, a public sector organisation has peculiar characteristics with regards to KM.

A major characteristic of managing knowledge in a public sector organisation is the

existence of extra information sources and transformers of information (Gramatikov,

2004). The knowledge that is used in a public organisation is also categorised as

unstructured and challenging to process and computerise. As a result, knowledge in a

public organisation is usually considered difficult to standardise and share. While these

reasons should not preclude the sharing of such innovative reforms between sectors, there

is no established body of knowledge on successful management strategies in the private

sector that can be drawn upon by public organisations.

The extant literature reveals relatively few studies on KM in the public sector (Riege &

Lindsay, 2006; Syed-Ikhsan & Rowland, 2004a; Cong & Pandya, 2003). Researchers

also admit that KM is a relatively recent phenomenon in the public sector (Wyatt & Liu,

2002; Booth & Walton, 2000). Available studies (Table 3.1 below provides a tabular

review of key studies) tend to be theoretical (exceptions include Syed-Ikhsan & Rowland,

2004a and Syed-Ikhsan & Rowland 2004b). Fewer studies still have investigated KM in

public healthcare organisations such as public hospitals (Van Beveren, 2003). Burns et al.

(2004) state that KM, although recognised as important to organisational performance,

has to date only been formally applied in healthcare organisations to a limited extent. So

far the public sector appears slow to adopt and implement KM. Skyrme (2003) states that

only a small proportion of public sector organisations in Australia have a KM program in

place.

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Table 3.1: Studies of KM in Public Sector Organisations

Author Description of study Methodology

Findings

Hasan (1999)

Looks at the mediating role of

technology in making sense of

information in a university

Document scanning,

interviews and

observation

Ideal solution integrating different technologies

may be difficult to achieve and require more

resources than the university could afford.

McAdam &

Reid (2000)

Compares public and private

sector perceptions and their use

of KM

Research survey and

participative

workshops

KM was more developed as a management

philosophy in the public sector. This development

has been caused by continual pressure for

increased efficiency, reduced resources and

improved quality within the public sector.

Shields et al.

(2000)

Looks at KM initiatives in the

Canadian Federal Public Service

Interviews and

document scanning

Developed six broad considerations for successful

initiatives regarding knowledge and information in

the workplace.

Wiig (2002)

Studies how KM could play an

important role in public

administration

Theoretical

Important to have comprehensive KM within and

in support of public administration to enhance

decision making and situation handling.

Syed-Ikhsan &

Rowland

(2004a)

Studies the relationship between

organisational elements (culture,

structure, technology, human

resources, political directives)

and the performance of

knowledge transfer

Research survey

There are significant relationships between some

of the variables and the performance of knowledge

transfer.

Syed-Ikhsan &

Rowland

(2004b)

Investigates and examines the

availability of a KM strategy in

a public organisation

Research survey

KM as a practice could be the most influential

strategy in managing knowledge in public

organisations.

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3.2 An Overview of the Australian Public Healthcare Sector

The healthcare sector in Australia represents a significant portion of the Australian

economy. The Australian Commonwealth Government spent approximately ten percent

of the Gross Domestic Product (GDP) on healthcare in 2005 (Kankhar, 2006). A report

by the Australian Bureau of Statistics (ABS) in 2006 showed a combined annual

expenditure by the public and private healthcare sectors at approximately AUD$79

billion in 2003-2004. The Australian Commonwealth Government finances

approximately forty seven percent of this annual expenditure through grants to the States

and Territories for public hospital services (via Australian healthcare agreements) and

rebates for medical services (under the Medicare Benefits Schedule) and pharmaceuticals

(through the Pharmaceuticals Benefits Scheme). State and Territory Governments finance

approximately twenty three percent of health spending, while the remaining thirty percent

is financed privately (via private health insurance premiums and out-of-pocket expenses)

(NHIMAC Action Plan, 2001). In Australia, the Commonwealth Government also plays

the leading role in policy formulation, particularly in areas such as public health, public

health research and public health national information management (Houghton, 2002).

The healthcare product system diagram in Figure 3.1 below provides a general overview

of the key stakeholders including suppliers (suppliers of generalist and specialist services,

materials and equipment), regulatory bodies, healthcare provides and clients that make up

the core value chain and contribute to the development, production and delivery of

healthcare services.

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Figure 3.1: A Schematic Healthcare Product System (adapted from Houghton, 2002)

The key stakeholders are supported by a collective support infrastructure (for e.g.

education and training institutions and R&D providers) and operate within an

overarching regulatory framework including drug approval processes and various

government formularies.

3.2.1 Australian Public Hospitals

Large urban public hospitals in Australia provide the majority of the more complex types

of hospital care such as intensive care, major surgery, organ transplants, renal dialysis

and non-admitted patient care (Houghton, 2002). Public hospitals in Australia have their

own pharmacies that provide medicines to admitted patients free of charge. Public

hospitals also provide the majority of acute care beds in Australia and are funded by the

75

Australian Commonwealth Government, State and Territory Governments, in addition to

receiving revenue for services from private patients.

Table 3.2 below shows that in 2003-2004 there were 761 public hospitals nationally,

including 20 psychiatric hospitals compared with 748 in 1999-2000. There was an

average of 53,327 beds in public hospitals during 2003-2004, representing sixty seven

percent of all beds in the public and private hospitals combined. Public hospital beds

have declined from 2.8 beds per 1,000 population in 1999-2000 to 2.7 beds in 2003-2004.

Table 3.2: Public Hospitals - 2003-2004. (Adapted from ABS (2006) Year Book Australia, 2006)

The number of patient separations (discharges, deaths and transfers) from public hospitals

during 2003-2004 was 4.2 million compared with approximately 3.9 million in 1999-

2000. Same-day separations accounted for forty nine percent of total public hospital

separations in 2003-2004 compared with forty six percent in 1999-2000. Total days of

Healthcare Delivery and Financing

Units

Public Hospitals

Bed Supply

Facilities Beds/chairs

Activity

Total separations Same day separations Total patient days Average length of stay Average length of stay excluding all same-day separations Average occupancy rate Non-admitted patient occasions of service Staff (full-time equivalent) Revenue Recurrent expenditure

no. no.

‘000 ‘000 ‘000 days

days %

‘000 ‘000 $m

$m

761

53,327

4,200 2,057

16,418 3.9

6.7

84.2 43,622

205 1,640

20,013

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hospitalisation for public hospital patients during 2003-04 amounted to 16.4 million, an

increase of one percent since 1999-2000. The average length of hospital stay per patient

in 2003-04 was 3.9 days. For 1999-2000 the corresponding figure was 4.2, reflecting the

lower number of same-day patients compared with 2003-2004. If same-day patients are

excluded, the 2003-2004 average length of stay was 6.7 days compared with 6.9 days in

1999-2000.

Table 3.2 above also shows that an average of 205,000 staff (full-time equivalent) were

employed in public hospitals in the 2003-2004 period with the total revenue amounting to

AUD$1.64 billion. Recurrent expenditure amounted to AUD$20.01 billion of which

salaries and wages accounted for the major percentage. The difference between revenue

and expenditure is made up by payments from State and Territory consolidated revenue

and specific payments from the Australian Commonwealth Government for public

hospitals.

3.3 Importance of KM in the Public Healthcare Sector

A hospital may be defined as an organisation with an overlap of parallel structures. One

part of this structure, the administrative and the support function offers services such as

materials and facilities. Another part of the structure provides medical services (Costa et

al., 2004). Hospitals can generate massive amounts of ‘knowledge-rich’ healthcare

information that comes from inside and outside of the healthcare environment and is

indispensable for its proper functioning (Kisilowska, 2006). Abidi (2001) categorises the

different types of knowledge in healthcare as including tacit and explicit knowledge of

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healthcare practitioners, healthcare related documents, data, processes, workflows,

experiences and lessons learnt. This information includes electronic medical records,

clinical trial data, hospital records, administrative reports and benchmarking findings.

Knowledge is therefore considered a critical resource in the provision of healthcare

(Moody & Shanks, 1999) and the public healthcare sector is an essential component of

the public sector that is powered by sophisticated knowledge and information resources

(Haux, 2006; Abidi, 2001). Healthcare providers such as hospitals are considered

knowledge-intensive organisations with highly knowledgeable employees, high levels of

specialisation and knowledge-based processes (Ellingsen, 2003). KM in healthcare is

regarded as the confluence of formal methodologies and techniques to facilitate the

creation, identification, acquisition, development, preservation, dissemination and

utilisation of the various facets of a healthcare enterprise’s knowledge assets (Abidi,

2001; Cheah & Abidi, 1999). In the current knowledge-centric healthcare organisation,

knowledge is deemed central to what Sveiby (1997) refers to as, an organisation’s

capacity to act. Van Beveren (2003) states that healthcare organisations (i.e. hospitals)

could be viewed as a collection of professional specialists who contribute to the delivery

of patient care. They are deliberately referred to here as a ‘collection’ of professional

specialists as often they work in discrete divisions within the organisation, thus leading to

a fragmentation in the delivery of care. This has a profound effect on knowledge sharing

throughout the organisation.

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With such a vast amount of information to be accessed, shared and utilized by healthcare

professionals, one of the key objectives of KM in hospitals is to insulate its knowledge

from degeneration. This is achieved for example through the capturing and sharing of the

tactical expertise and experience of individual workers. This must also be reflected in its

organisational strategies, policies and practice at all levels of the hospital management

and patient care activities (Bansal, 2001). As organisations that continually stress

consistency, process quality, decision making and quality service delivery, hospitals are

viewed as prime candidates for KM.

Hospitals are however also facing major problems in communication and collaboration.

Abidi (2001) describes them as ‘knowledge poor’ because the massive amount of

information generated is rarely transformed into a strategic decision-support resource.

Quick and easy access to clinical, operational, administrative and managerial information

is critical. Effective decision making and awareness within hospitals depends on the

access and usage of the available information. This is particularly important for public

hospitals that must match constant budgetary pressures with the information needs of the

numerous stakeholders. These stakeholders include patients and their families, the multi-

disciplinary hospital staff, the general public, politicians and various levels of

government (Lorenzi & Riley, 1994).

According to Mantzana & Themistocleous (2005), the development and usage of an

integrated healthcare IT infrastructure that enhances service delivery is thus a priority for

the healthcare sector. The transformational ability and implications of the usage of IT

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tools for supporting KM as part of that facilitating infrastructure are considered important

in ensuring enhanced access, sharing, creation and storage of knowledge. It is believed

that this would lead to the formation of a more participatory and collaborative work

environment where healthcare professionals are able to interact more effectively with

each other. This interaction could occur through one-to-one, one-to-many or many-to-

many features of an IT tool which facilitates learning and enhances the knowledge of the

users. The usage of such IT tools to facilitate KM is consequently regarded as essential in

today’s hospitals (Bansal, 2001). The following section examines the potential impact

and benefits of IT usage in Australian public hospitals with a particular focus on the

Intranet.

3.4 Australian Public Hospitals and the Potential Impact and

Benefits of IT Tools

As previously pointed out, healthcare is an information intensive profession (Haux, 2006;

Abidi, 2001) and access to and sharing of that information is critical (Reinecke, 2004;

Stratton, 2001). There is therefore an increasingly important role played by IT in the

functions of health services (Southon, 1999). While research suggests that IT is slowly

emerging in healthcare (Ammenwerth et al., 2003; Dixon, 1999), it is no longer perceived

simply as a supporting tool. Rather, it is viewed as a strategic necessity that will

significantly improve healthcare services and ultimately save lives. Table 3.3 below

shows the potential adverse impact experienced in healthcare service delivery when IT is

not used in the Australian health system.

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Outcome

Impact on the Health Systems

Additional Cost of Adverse

Events

An indirect cost of approximately $1billion (litigation,

compensation).

Reduced Patient Safety

Approximately 4,000 deaths per annum (pa) from preventable

medical errors.

Reduced Quality of Care

19,000 per million admissions resulting from preventable

medication. Approximately 5,000 times as many errors as for

world-class manufacturing and service companies.

Poor Continuity of Care

Greater than 10% of General Practitioners (GP) consultations

potentially based on inadequate or insufficient information.

Variable Privacy Protection

Inconsistent privacy protection of patient information;

susceptible to misuse and fraud.

Administrative Inefficiency

Administrative overheads from manually recording and

communicating health information, e.g. approximately $13,100

pa cost per GP completing Commonwealth forms manually.

Table 3.3: Adverse Impact of not Using IT in Hospitals. (Source: NEHTA Analysis; HealthConnect Indicative Benefits Study; Australian Council for Quality and Safety in Health Care; Australian Institute of Health and Welfare)

The Australian National Health Information Management Advisory Council (NHIMAC)

Action Plan (2001) stresses that access to necessary information at the time care is

delivered is central to good clinical decision-making. Healthcare practitioners and other

stakeholders require the right information at the right time. The increasing shift of

healthcare service delivery out of hospitals and into the community has also led to a

wider range of services being utilised. This frequently results in the duplication of time

and effort through the repetition of assessments, testing and information collection. The

greater focus of healthcare policy on providing seamless care, particularly for the aged,

the chronically ill, and those with other complex care needs, has highlighted the need to

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improve information exchange between different types of services and healthcare

practitioners. Lorenzi & Riley (2003) thus explain that in healthcare, IT is central to the

need for change and rapid, efficient and continuous adaptation.

Researchers have highlighted numerous benefits from the use of IT. IT tools in general

offer outstanding opportunities to reduce clinical errors (e.g. medication and diagnostic

errors), support healthcare professionals (e.g. availability of timely and up-to-date patient

information), increase the efficiency of care (less waiting time for patients) and improve

the quality of patient care (Ammenwerth et al., 2003). Houghton (2002) for example

suggests that there is an enormous range of opportunities for significant cost reductions,

service enhancements and behavioural change in healthcare through IT usage under what

is also often broadly referred to as ‘E-health’. As Lohman (1999) explains, E-health

opens up entirely new paths of communication and transactions in healthcare. It fosters

radically new business patterns and organisational configurations. Kankhar (2006) in

agreement asserts that IT plays a major role in healthcare delivery across the world and

has improved the quality of patient care. IT has helped reduce errors in healthcare

delivery and has led to greater efficiency in healthcare services than has previously

existed through optimising the usage of resources (Kankhar, 2006).

Goldsmith (2000) investigated the impact of Internet technology on the United States

health system. The research concluded that there was a significant potential to

fundamentally transform both the structure and the core processes of medicine through

the usage of the Internet technology. Goldsmith (2000) further discussed Intranet

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technology as offering more significant potential than seen by any other new technology

in the past fifty years. As a result, the demand for health-related IT has led to a

proliferation of businesses that provide hardware, software, technical support and

sometimes entire information systems to the healthcare industry. The usage of advanced

web-based IT tools in public hospitals also creates as Rusanow (2003) explains, an

expectation from both within and outside the hospital of faster and improved healthcare

service delivery. IT is therefore most likely to be a main priority for the healthcare sector

worldwide and will result in enhanced services that will improve and save human lives

(Mantzana & Themistocleous, 2004).

Researchers also point out the potential benefits of IT tools particularly for KM in

healthcare. Some of these benefits include supporting healthcare professionals in

hospitals such as medical doctors, administrative staff, nurses and patients (Haux, 2006),

improving access to updated medical knowledge at the moment of need and at the point

of care (Pluye et al., 2005) and acting as evidence-based decision support systems (Short

et al., 2004; Eisenberg, 1999).

In hospitals, IT tools that support KM would allow for the generation of new

organisational forms of healthcare delivery that would not otherwise exist (Berg, 2001).

They are designed to simplify and speed up administrative processes within the

healthcare system and minimise the duplication of paperwork (Espinosa, 1998). IT tools

that support KM would furthermore facilitate the development of new competencies for

healthcare professionals (Berg, 1999) and help to tackle the problems of information

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overflow in clinical practice (Hersh & Hickam, 1998). This would consequently allow

data to be extended not only to patient care, but also for healthcare planning and clinical

research (Haux, 2006). Table 3.4 below outlines some of the potential impacts of IT on

key stakeholders in the healthcare industry.

Healthcare Providers

The entire healthcare system could reap significant gains from an integrated

approach to supply chain management that includes the entire range of hospital

and medical supplies and linkages to other players in the healthcare system.

Electronic scheduling and patient management systems could improve scheduling

of tests and procedures, and thereby reduce the length of hospital stays and reduce

the need for multiple visits. Linking insurers, healthcare providers, financial

institutions and consumers into claiming and payments systems also has the

potential to reduce significant administrative costs and improve the quality of

service.

Healthcare Practitioners

From the perspective of individual medical practitioners, knowledge enrichment or

research and education, practice administration and clinical tools are among the

most important IT applications. These clinical tools hold significant promise, both

in terms of direct efficiency and cost savings and in terms of influencing the

behaviour and practices of the GPs.

Patients

The relationship and balance of power between patients and providers is being

altered, leading to more empowered consumers and enhanced self, home and

community care capabilities. Perhaps the greatest change in the patient-provider

relationship will be brought about by the use of the Internet by patients. Broshy et

al. (1998) suggested that two types of information will be particularly important –

information about managing health and chronic disease, and information about

provider quality and cost. With the rise of more informed patients, there will be

increasing scope for stakeholders to influence healthcare behaviour, prescription,

and treatment.

Table 3.4: The Impact of IT Tools on Key Stakeholders in the Healthcare Industry (Adapted from Houghton, 2002)

84

Other benefits of IT tools that support KM in healthcare include improved knowledge

sharing at all levels, thus providing the ability to transform the diverse stakeholders in the

hospital into a healthcare knowledge network. One particular IT tool being rapidly

introduced at hospitals to support the fulfilment of such healthcare objectives is the

Intranet (Ong et al., 2001) One particular IT tool being rapidly introduced at hospitals to

support the fulfilment of such healthcare objectives is the Intranet (Ong et al., 2001). For

example, Intranets are able to facilitate knowledge sharing on a one-to-one, one-to-many

or many-to-many basis in a hospital. On a one-to-one basis, healthcare practitioners are

able to communicate and collaborate through E-mail and other instant messaging

systems. Intranets also include applications that can facilitate two-way interactions, such

as help desk requests and HR requests. On a one-to-many basis, hospital clinical and

practice guidelines that are relevant for the everyday usage of healthcare professionals

can be presented and shared. This helps to eliminate the costs of producing, printing and

distributing this necessary information. On a many-to-many basis, Intranets also enable

communication and collaboration through the provision of newsgroups, discussion areas

or bulletin boards that facilitate direct interaction and exchange of information between

multiple users.

The Intranet is a cost-effective IT tool. It is a simple and flexible solution that enables

information from different legacy systems to be brought together on one screen

(McDonald et al., 1998). It provides a way to tightly integrate previously divergent

information such as established practice guidelines and clinical information contained in

electronic patient medical records. Healthcare services can also be consolidated and

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optimised across multi-practice areas or multi-disciplinary functions in the hospital with

customised access at multiple levels of hospital, department, practice or physician levels

(Dixon, 1999). Public hospitals like all other hospitals create and revise vast amounts of

paper documents, including, for example, procedure manuals, policies and guidelines. An

Intranet provides the means whereby only the most current indexed and searchable copy

of each document is maintained and available. Authorised changes may be made online

and the necessary secure access granted to users regardless of location and time, thereby

eliminating printing costs (Wyatt, 2000).

The Intranet is usually linked to and is the backbone of the Hospital Information System

(HIS). The HIS can be viewed as comprising hardware configuration, software and

terminals. The aim is to collect, store, process, retrieve and transmit information

concerning patients and administration primarily to support groups of specialised

professionals working directly with hospital patients. They also assist affiliated clinical

departments and ambulatory medical services (Costa et al., 2004). Makhani (2004) points

out that there is a shift in healthcare organisations from the old healthcare paradigm of

the HIS system to a new one of an organisation-wide KM system. An Intranet therefore is

perceived as being able to play an enabling role in the organisation-wide KM system in

this paradigm shift.

Intranet applications in hospitals include being used to support clinical practice

guidelines (Stolte et al., 1999), for the presentation of radiology test results (Gaudin,

1998), disease management (Keever & Shulkin, 1998), paging services (Moozakis, 1998)

86

and as a link between emergency departments (Galdwin, 1998). Other researchers (see

Bobrowski & Kreymann, 2005; Darmoni et al., 2000; D'Souza et al., 1999; Willing &

Berland, 1999) point out examples of how Intranet functions facilitate the improvement

of clinical practice, quality of service delivery and patient outcomes in hospitals. The

result is that healthcare professionals are better informed, continuously updated about the

latest tools and best practices and are able to make quick and informed decisions thus

helping to fulfil core healthcare objectives (Bansal, 2001).

Key findings of a 2005 Healthcare Information and Management Systems Society

(HIMSS) survey of healthcare IT executives showed that the Intranet was among the

most commonly used technologies. Ninety six percent of the healthcare IT executives

surveyed reported their organisations use of an Intranet. The Intranet as an Internet-based

IT tool has proven to be simple yet revolutionary, providing large scale access to

information while enabling communication and collaboration in hospitals. It has the

potential to minimise healthcare costs and improve the quality of care. This is made

possible by providing and sharing clinical information in a timely manner. Table 3.5

below summarises some of the highlighted benefits of Intranet applications in a hospital.

Function

Examples

87

Table 3.5: Intranet Applications in a Hospital (adapted and modified from Wyatt, 2002)

3.5 Intranet Usage in Australian Public Hospitals

According to Bakker (2002), the healthcare sector lags behind other sectors in the use of

IT. In Australia, the healthcare sector is significantly behind other sectors in the adoption,

application and integration of IT into practices, institutions and the provision of

healthcare services (Houghton, 2002). In addition, the Department of Health in Australia

as the primary regulatory body has spent considerably less money on IT compared to

other government sectors. This has resulted in the adoption of inefficient, fragmented and

outdated IT systems by healthcare providers such as hospitals (Kankhar, 2006).

Publishing and Browsing Content

Electronic medical records/Computer-based patient record systems. Hospital quality standards and protocols. Hospital annual reports. Laboratory handbooks and material safety data sheets. Practice guidelines, care manuals and protocols. Regulatory standards. Research/lab reports. Multimedia presentations and medical imaging. News and happenings.

Accessing Databases

Drug and disease information. Clinical evidence. Library catalogues and access to relevant journal articles/conference papers. Dynamic knowledge bases and multimedia content. Shared unit/departmental directories. Best practice documents. Regulatory documents.

Interactive Tasks

Bulletin boards. Communication using employee work schedules and calendars. Online paging/Short messaging service (SMS). Clinical information systems. Online learning/E-Learning resources and self-help tutorials. Online ordering and resource scheduling including self-help forms. Online human resource forms (e.g. claims processing, employee benefits, leave applications, job descriptions and applications). Collaborative tools including video-conferencing. Linkage to hospital instruments and mobile computing devices such as Personal Digital Assistants (PDA)’s.

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A 2001 Collaborative Health Informatics Centre (CHIC) report stated that the average IT

budget across all health organisation types in the Australian health IT market amounted

to 2.4 percent of the total health budget — ranging from one to ten percent. In agreement,

the Chief Executive Officer (CEO) of the Australian National E-Health Transition

Authority (NEHTA) points out that the inadequate levels of investment in IT is an

infallible indicator of the inadequate practice in capturing, storing and transferring

information (Reinecke, 2004).

This view led to a 2005 Australian Health Care Reform Alliance (AHCRA) forum to

conclude that there is a:

“. . . Need to examine the potential benefits that new technology, including E-

health solutions, may bring to improving the quality and safety of our nation’s

primary care services. We need to ensure our primary care health professionals

have ready access to the best available evidence to support clinical decision

making. This needs to include access to key patient information through shared

electronic health records” (p. 3).

The Australian Commonwealth Government has undertaken major steps to overcome this

lack of strong IT infrastructure in the public healthcare industry by introducing some new

measures. Over $188 million has been allocated to facilitate the transition of paper-based

clinical record keeping to electronic means in order to provide better information

exchange (Thorp, 2002). An example is the Broadband for Health Program (a $60 million

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Australian Government Program) initiated to support eligible healthcare organisations to

establish advanced broadband services with the capacity to support secure electronic

messaging, shared electronic health records and other E-Health activities (Department of

Health and Ageing, 2006). Another initiative known as HealthConnect, a nation-wide

electronic health record program was also launched. This encouraged health departments

in States and Territories to overhaul existing legacy IT systems due to the need to set up

an ideal platform for HealthConnect (Department of Health and Ageing, 2006). These

initiatives have been a major driver in the development and usage of the Intranet as an

ideal platform capable of integrating, providing access to and allowing for the sharing of

both clinical and administrative information in Australian public hospitals.

The larger public hospitals have become increasingly aware of the important need to use

IT tools and have made some progress in the computerisation of internal information

functions. These have been implemented to efficiently and effectively enable and

expedite multifarious work processes. However, the use of IT for communicating or for

supporting clinical transactions is ‘generally primitive’. Public hospitals spend an average

of around one percent of their total budget on IT (CHIC, 2001). Hospitals in the public

healthcare sector are challenged to implement user-friendly, efficient and robust IT

systems to assure their organisation’s ability to survive and thrive in an increasingly cost-

conscious and customer-oriented environment that demands high quality service. Public

hospitals in particular have low budgets for IT tools and IT training. Coupled with the

high speed of change in healthcare, the chosen IT system must be sufficiently flexible

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and capable of development with minimum input from expensive IT staff (Fraser et al.,

1997).

The assessment of the impact of the Intranet in the extant literature shows a popular view

that it holds significant promise with regards the resulting efficiencies, cost savings and

its impact in terms of influencing the behaviour and practices of healthcare professionals.

It is noteworthy to consider however that certain barriers are faced in terms of realising

benefits. As pointed out in the introductory chapter, although previous research predicted

that Intranets would deliver multiple benefits to organisations (Hinrichs, 1997), recent

research has been less clear and in some cases disappointing (Damsgaards & Scheepers,

2001). Some studies have found that Intranets are poorly utilised, used for information

hoarding and in ways that reinforce existing structures, functional boundaries and status

differences rather than dispel them (Hislop, 2002; Newell et al., 2001; Newell et al.,

2002; Newell et al., 2003).

In other words, as Welch and Pandey (2003) point out, Intranet technology due to its

highly malleable nature, can lead to the creation of multiple interpretations and effects. In

a healthcare setting, Houghton (2002) explains that the adoption of such IT tools has been

relatively slow because of certain barriers including a range of practitioner concerns.

These practitioner concerns include patient privacy, security of patient records and the

possibility that the tools will generate activities that are not billable and/or reimbursable.

The cost of integrating clinical tools with current systems, the difficulty of use and

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possible interruptions to workflow and doctor patient interactions; and the cost and time

needed for training to effectively use the new tools are also of concern.

The lack of research into Intranets in general is highlighted by Blanning & King (1998)

who claim that the literature tends to consist of anecdotes about Intranet technology.

These accounts appear on the web pages of certain companies offering Intranet-related

products and services. There is therefore a lack of systematic studies of Intranet

applications (Blanning & King, 1998). Available studies of Intranets in hospital settings

have generally been descriptive, focusing on Intranet functionality and development

(Bobrowski & Kreymann, 2005; Kay & Nurse, 1999; Aymard et al., 1998; François et al.,

1998; Clark et al., 1997). An exception is Ong et al. (2001) who describe both an Intranet

development process as well as its usage. Table 3.6 below presents a summary of

available Intranet studies in hospitals.

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Table 3.6: Studies of Intranet Usage in Hospitals (continued on next page).

Author Description of study Methodology Findings

Bobrowski & Kreyman (2005)

Usage of Lotus Notes to enable the presentation and retrieval of clinical guidelines relevant for everyday usage of clinicians.

Intranet-based Lotus Notes development

Findings showed overall benefits to the hospital but with some technical shortcomings and acceptance problems on the part of physicians. Conclusion was IT should essentially support an integrative concept of knowledge management in (internal) medicine.

Connell & Blandford (2004)

Intranet usage and overall frequency in a hospital.

Questionnaire and interviews

Intranet was viewed as a positive asset. However, relatively little use was made of the Intranet in terms of overall frequency though some Intranet sites were used heavily. Reasons for low usage of the Intranet included access to personal computers (PC)s, network availability and staff uptake.

Lamb (2004)

Usage of Intranets in merging internal and external guidelines and for coordinating compliance with legislative initiatives and agency rulings at a hospital.

Series of empirical examples that draw on data from a multi-year, multi-industry study of Intranets in mid-western US organisations (1998-2003).

In the usage of Intranets for regulatory action, there was a need for the articulation of changes and local differences in information system use and the ability of boundary-spanners to introduce ways of working to bridge these gaps.

Ong et al. (2001) The use of the Intranet among physicians, nurses, managers, and other associates in a multi-hospital system and building the Intranet in a cost-effective manner using existing resources.

Used a WebTrends Log Analyzer to assess Intranet usage in terms of the number of accesses from each department.

A broad range of features were developed and diffused via the Intranet. However among key challenges included selling the potential of this new technology to opinion leaders and other stakeholders.

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Table 3.6 Studies of Intranet Usage in Hospitals (continued).

Author Description of study Methodology Findings

Aymard et al. (1998)

Information is usually available in a heterogeneous data format and various legacy sources. Investigates the integration of applications to access information via the Intranet.

A web-oriented stand-alone prototype accessing three types of information sources on the Intranet was implemented.

Possible to integrate and access various heterogeneous information sources within a hospital Intranet.

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Table 3.6 Studies of Intranet Usage in Hospitals (continued).

François et al. (1998)

Implementation of a database on drugs into a university hospital Intranet.

Product development.

Successful provision of an interface that provides end-users with an easy-to-use and natural way to access information related to drugs in an Intranet environment.

Clark et al. (1997)

Making Material Safety Data Sheets available on the corporate Intranet.

Product development.

Initial response from clinical and corporate departments has very been positive. All user requests were served within minutes.

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As shown in Table 3.5, few studies have focused on Intranet usage in public hospitals.

Therefore, this research adds to the body of knowledge on IT usage for supporting

KM in the public healthcare sector. It empirically investigates the usage of the

Intranet and its impact on knowledge sharing in a large and ultra-modern public

hospital. It also responds to the call for investigating the organisational conditions that

enable the usage and impact of the Intranet for knowledge sharing. This research is

conducted in Australia where it has been identified that very little insight exists as to

how widespread the usage and impact of these tools are in the public healthcare

sector.

A National Health Information Management Advisory Council (NHIMAC) (2001)

study stressed in its conclusion the need to address the organisational and cultural

aspects of how information is currently exchanged. It also emphasized the need to

address the barriers to this exchange before IT can be effectively used to improve the

management of clinical information. In addition, it is expected that the usage of the

Intranet and its potential impact would be affected by certain surrounding

organisational conditions governing its usage and impact. It is therefore of related

importance to this research that an investigation be conducted into key influencing

factors that could facilitate or impede the usage and impact of the Intranet in

supporting knowledge sharing. These key factors are addressed in the following

section.

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3.6 Enabling Organisational Conditions

3.6.1 Introduction

It is acknowledged that IT tools cannot be investigated within an organisation in a

vacuum (Berg et al., 1998). To guarantee successful usage, IT tools in general must be

adopted by users and integrated within their respective work-contexts (Malhotra,

2005). IT tools such as the Intranet are used in an organisational context, thus success

or failure is dependent on the organisational conditions surrounding its usage (Al-

Gharbi & Alturki, 2001). Southon et al. (1999) for example stress that the installation

of an Intranet alone will not necessarily fulfil core healthcare objectives in a hospital.

Organisational issues are therefore recognized as key factors in the effective usage of

IT tools. Subsequently, this section of the literature review addresses some of these

key organisational conditions that must be in place for the successful usage and

impact of the Intranet.

Previous research on IT usage in the public sector has found organisational factors to

have a greater influence on the use of IT than other external factors (see for e.g. Ang

et al., 2001). In the area of health in particular, it has become increasingly evident that

organisational issues are crucial and account for many of the difficulties and failures

involving IT implementation and usage in healthcare organisations (Haux, 2006;

Andersson et al., 2003; Berg, 2001; Berg, 1999). Although there are no pre-fixed sets

of organisational issues that come to play (Berg, 1999), there are some common key

enabling organisational conditions that must be in place in an organisation for the

effective usage and impact of IT tools such as the Intranet. Researchers (e.g.

Mantzana & Themistocleous, 2005; Snis & Svensson, 2004; Ammenwerth et al.,

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2003) have therefore stressed the importance of investigating and understanding the

surrounding organisational conditions.

These organisational conditions not only affect the usage and impact of the IT tool but

are also themselves likely to be affected and transformed by it. As Howcroft et al.

(2004) state, once adopted, an IT tool may influence the structure and culture of the

organisation. See also Robey & Azevedo (1994) and Knapp (1998) for similar

conclusions.

It is important to point out that it is not the objective of this research to generate a list

of every possible organisational condition that could facilitate or impede the positive

impact of IT tools that support KM. This research does however aim to investigate the

key factors as identified and discussed in the literature in relation to this exploratory

research. These include the following factors reviewed below.

3.6.2 Knowledge Sharing Culture

As Oliver & Kendadi (2006) point out, the extant literature emphasizes the

inseparable relationship between organizational culture and KM (Davenport &

Prusak, 2000; Krogh et al., 2000; Nonaka and Takeuchi, 1995). Several researchers

(e.g. Pyoria, 2007; Stenmark, 2003; Bansal, 2001; Damsgaard & Scheepers, 2001;

Hislop, 2001; Choo et al., 2000; DeLong & Fahey, 2000; Jarvenpaa & Staples, 2000;

Davenport et al., 1998; Ruggles, 1998; Telleen, 1997) stress that an organisational

culture that promotes knowledge sharing is necessary and is the most important factor

for the successful usage of IT in supporting KM. Organisational culture, according to

Alvesson (2002), are a body of solutions to problems that have worked consistently

and are taught to new organisation members as the correct way to perceive, analyse

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and feel in relation to those problems. It encompasses the values, beliefs, attitudes and

norms that bind members of an organisation together (Lemken et al., 2000). It may be

thought of as the manner in which an organisation solves problems to achieve its

specific goals and to maintain itself over time. Snis & Svensson (2004) explain that

organisational culture is viewed as being holistic, historically determined, and socially

constructed and therefore difficult to change. Davenport & Prusak (2000) suggest that

organisations take a hard look at their culture before launching a KM initiative. This is

because it could act as one of the greatest barriers in the implementation of KM

(Bouthillier & Shearer, 2002). It is argued that as long as all members belong to the

same culture, they have the required background knowledge to understand a problem.

The norms exhibited in the organisation encourage its members to search for or

develop new ideas, share those ideas while accepting the ideas of others. IT tools can

be regarded as artefacts that reflect these shared norms and social values (Robey,

1995).

Zack & Mckenney (1995) emphasize that organisations must create a social climate

and work context that supports and promotes knowledge sharing through openness

and trust, cooperation and collaboration, continual search for knowledge and truth,

and a respect for others’ knowledge and expertise. Oliver & Kandadi (2006) refer to

this as a knowledge culture or a way of organisational life that enables and motivates

people to create, share and utilize knowledge for the benefit and enduring success of

the organisation. Accordingly, if the norms in an organisation encourage the open

flow of information and knowledge then users may be expected to use the IT tool to

enact the norm (Jarvenpaa & Staples, 2000). The rationale therefore is that if the

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organisational culture is not conducive to knowledge sharing then the usage of IT

tools such as the Intranet will not be effective (Curry & Stancich, 2000; Kock, 2000).

The need for a culture that is conducive for knowledge sharing is frequently

acknowledged as a key organisational condition in private sector organisation studies.

Cong & Pandya (2003) view culture to also be one of the key elements to be

considered when implementing KM initiatives in the public sector. They further

explain that one of the public organisation’s main KM implementation barriers stems

from the absence of a sharing culture. The success of KM initiatives depends upon an

individual’s willingness and ability to share knowledge and establish a culture within

an organisation (including values and behaviours) that is ‘right’ for KM. This is

typically the most important and yet often the most difficult challenge.

The lack of a knowledge sharing supportive culture appears to be more prevalent

within organisations in the public sector. This effectively creates an impediment to the

implementation of KM initiatives. Wimalasiri (1993) in a comparative analysis of

private and public sector organisations found that fifty percent of public sector

employees from a large random sample held a negative view of the supportive nature

of the environment in which they work in comparison to seventy percent in the private

sector. Therefore, a culture that is conducive to knowledge sharing is associated with

the positive usage and impact of the Intranet on knowledge sharing in a public

hospital.

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3.6.3 Structure Governing the Intranet

An organisation is composed of a structure, defined as the rules and resources, sets of

routinised social practices, and the people who interact regularly within its spatial and

temporal boundaries (Orlikowski, 1992). Robbins et al., (2004:466) define the

structure of an organisation as the ways in which job tasks and responsibilities are

formally divided, grouped and coordinated within it. Organisational structures may

create boundaries which emerge due to the tight departmentalisation that occurs.

These boundaries are often difficult to penetrate and may make inter-departmental

communication and collaboration unlikely to occur (Miles et al., 2004). Therefore,

organisational structures within organisations may encourage or inhibit KM processes

(Nonaka & Takeuchi, 1995).

As previously stated in section 3.3, the structure of public sector organisations has

traditionally been highly bureaucratic, centralised, compartmentalised or siloed. This

poses a significant barrier to effective KM as a result of the multilevel and

administrative hierarchy (Robbins & Barnwell, 1994; Prokopiadou et al., 2004;

Sveiby & Simons, 2002). Newbold et al. (2004) stress that structure as an

organisational factor surrounding the usage of IT in healthcare organisations is very

important. Healthcare organisations are traditionally highly hierarchical (Hypponen et

al., 2005). The public healthcare sector is no different. For hospitals in this sector the

process of knowledge sharing becomes difficult and overcomplicated across different

units and different organisational levels. As a result, in larger organisations in

particular, the Intranet becomes more difficult to sustain due to the problems

associated with the maintenance of large volumes of data and complex network

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typologies (Betts, 1997). Berg et al. (1998) believe that in the context of medical

work, structure is a sine qua non for the functioning of IT.

Structure in terms of IT usage can be regarded as the sets of rules, policies and

procedures governing the administration and usage of the particular IT tool.

Researchers have pointed out that an ability to effectively manage the Intranet is one

of its significant constraints to usage (Duane & Finnegan, 2003; Bernard, 1997;

Hinrichs, 1997). Organisational structure governing Intranets is usually classified into

two approaches as follows:

Centralised: Researchers (Ghoshal et al., 1994; Tsai, 2002) have viewed

centralisation as one of the fundamental dimensions of structure.

Centralisation refers to the degree of authority and control over decisions

(Quinn et al., 1996). The Intranet is thus controlled and driven from the top

down, usually by the central IT department. It is centrally monitored, with

structured content, formal directives and rigid guidelines regarding usage.

Publishing or minor modifications also require centralised authorisation and

approval. The overall Intranet layout is also consistent under this approach.

Decentralised: The Intranet in this case is governed and driven from the

bottom up. Usually controlled by divisions and departments who are

responsible for their homepages, the structure is informal. The Intranet in this

regard is personalised and customized in terms of layout to suit the needs and

requirements of the users. Research points to the need for a decentralised

structure to enhance knowledge sharing. For example, Tsai (2002) found the

relationship between the level of decentralisation and knowledge sharing to be

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positive and the level of centralisation to be negatively associated with

knowledge sharing.

According to Van Beveren (2003), a structured approach governing the Intranet might

be deemed necessary given the legal, ethical and moral obligations encompassing the

provision of healthcare. Damsgaard & Scheepers (2000) in support, claim that Intranet

content and use must be controlled via standardisation and formalisation. Unless

procedures and routines are established and enforced, the Intranet will collapse they

argue, and therefore rationalisation and management control must be the

superordinate goals.

Lamb & Davidson (2000) explain that the role of monitoring and control had

previously rested in the hands of the IT department that could manage and control

some aspects of computerization more effectively than other personnel. For example,

to ensure the security and integrity of data and networks and taking into consideration

the needs of the whole organisation, IT departments are keen to impose ‘order’, secure

corporate data, monitor network traffic, set limits on what employees can do on an

Intranet, ensure documentation and continuity of user-developed Intranet websites and

reduce duplications of effort (Sliva, 1999). However, as Lamb & Davidson (2000)

stress, in the Intranet era, ‘end users’ cannot be treated by IT professionals as low-

level, computer-fearful data-entry employees who do not know what they want or

need in computerized applications. Instead, many are technologically savvy and have

far superior knowledge of the content needed in Intranet applications.

Other researchers such as Matsumoto (1997) suggest that a decentralised

organisational structure is a better fit for Intranets. Centralised management and strict

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policies on Intranet development are not usually advisable because it stifles

innovation. Stenmark (2003) explains that the Intranet has been subjected to the

standardisation and control urge that shaped organisations of the industrial age. This

mechanistic approach with its need for control and measurement affords organisations

the comforts of stability, order and control. It has been advocated by the management

literature at large. Stenmark (2003) further advocates that Intranets break with the

mechanistic control paradigm that plagued traditional IT tools and therefore should

have a decentralised structure.

A strictly hierarchical and bureaucratic structure does not support the usage of IT

(Lenk et al., 2002). Curry & Stancich (2000) explain that a hierarchical structure can

limit the ability to act on information presented on the Intranet. This leads to websites

having restricted access and forms that require downloading, submission for approval

and forwarding to a relevant person with data re-entered manually. The strategic

effectiveness of Intranets they explain can often be hampered by the extent of control

given to IT departments. If decisions relating to content and structure are made by

technical staff, it may create a lack of business focus with the resulting Intranet not

sufficiently reflecting business needs. A decentralised structure is argued to positively

affect the usage of the Intranet for knowledge sharing.

In summary, this section has reviewed influencing factors affecting the usage and

impact of IT tools on knowledge sharing. A knowledge sharing culture and a

decentralised structure have been advocated as important enabling organisational

conditions that have to be in place for the successful usage and impact of IT tools

such as the Intranet, these factors are therefore worthy of investigation.

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3.7 Conclusion

The first part of the literature review for this research examined the concepts of

knowledge, KM and the KM processes of knowledge sharing as represented by

Nonaka & Takeuchi’s (1995) knowledge conversion model. The Intranet, its types,

characteristics, usage modes and potential impact were also examined in detail. The

nature, usage and impact of the Intranet as an IT tool for supporting KM were also

reviewed. The second part of the literature review examined the public sector and

need for KM particularly in the public healthcare sector in Australia. It established

that the need for improved effectiveness and efficiencies in quality service-focused

organisations with critical and emergent work activities such as public hospitals has

put the value of knowledge sharing at a premium. It also presented the potential

benefits of the usage of IT support tools such as the Intranet for KM in public

hospitals. In addition, the enabling organisational conditions that could facilitate the

usage and impact of IT tools that support KM were presented. The importance of a

knowledge sharing culture and decentralised structure governing the Intranet have

been highlighted as critical to facilitating the usage for KM. The following issues and

gaps can be identified from the literature review:

The conflicting nature of results on the usage and impact of IT tools in general in KM

provide a blurred picture of the role of these tools for supporting KM. There is a

growing interest in new and modern IT tools such as Intranets confirmed by the

millions of dollars in investments as well as numerous articles in popular media and

practitioner articles. Despite this evidence, empirical research studies remain scarce,

especially in terms of support for KM (Gottschalk, 2000). In comparison to other

areas of organisational research, the research into IT tools that support KM in

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organisations is still in its infancy. Empirical research into advanced IT tools with rich

application modes such as the Intranet is scarce. This includes research studies

investigating the usage and impact of IT tools in particular on the key KM process of

knowledge sharing. In response to Gallupe's (2001) and Alavi’s (2000)

recommendation for further research into the tools that support KM, this research fills

a gap in the literature by providing a greater understanding of the role, usage, impact

and management of the Intranet in the knowledge sharing process.

Relatively few studies have been performed on KM in the public sector in general

(Syed-Ikhsan & Rowland, 2004; Cong & Pandya, 2003). Fewer studies still have been

done on the usage of IT for supporting KM in public healthcare sector organisations

such as hospitals (Van Beveren, 2003). This is especially true of Australian public

hospitals. Available studies of Intranets in hospital settings have generally been

descriptive, and focused on Intranet functionality and development. There is therefore

a need for research into IT tools in the healthcare sector (Haux, 2006).

Previous studies on IT usage in the public sector have also found that organisational

factors have more influence on the use of IT than other external factors. In the area of

health in particular, it has become increasingly evident that organisational issues are

crucial and account for many of the difficulties and failures involving IT

implementation and usage in healthcare organisations (Haux, 2006; Andersson et al.,

2003; Berg, 2001; Berg, 1999). It is thus equally important to investigate the enabling

organisational conditions that facilitate the impact of Intranet usage for knowledge

sharing while also taking into consideration the distinct characteristics of public sector

organisations.

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An exploratory and empirical case study will subsequently be carried out in a selected

large public hospital investigating the usage and impact of the Intranet on knowledge

sharing. The research will additionally investigate the factors influencing the effective

usage of the Intranet for knowledge sharing, including the impact of enabling

organisational conditions and impeding barriers on the usage of the Intranet in an

Australian public hospital where little insight exists into the role, extent of usage and

impact of such IT tools. A detailed explanation of the empirical research and

accompanying phases are discussed in the following part of the thesis.

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PART II- THE EMPIRICAL STUDIES

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Chapter 4-Overview of the Empirical Research, Choice

and Justification of Methodology


In the carrying out of any research, the research method(s) used would need to

provide the rigour, richness and depth required to answer the research questions

developed. An in-depth exploratory case study approach was selected and conducted

in three phases at the selected organisation (a large public children’s hospital in

Australia). It makes use of a combination of research methods to ensure data richness

and support of analyses. Each phase while using a different method and focus is able

to reinforce the other.

This chapter presents a discussion of the methodological approaches adopted. It

examines the choice and justification of research methodology, provides a description

of the exploratory case study method and outlines the measures adopted to ensure

integrity and validity of the research.

4.1 Choice and Justification of Research Methodology

This research mainly adopts an interpretivist methodological approach (Guba &

Lincoln, 1989). Interpretive studies generally attempt to understand phenomena

through the meanings that people assign to them with the underlying assumption that

access to reality (given or socially constructed) is only through social constructions

such as language, consciousness and shared meanings (Myers, 1997). To construct an

understanding of user experiences of the Intranet, the research aimed at using a

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flexible data collection procedure for gathering relevant data (Benbasat et al., 1987).

An in-depth exploratory case study approach was selected employing a combination

of qualitative and quantitative research methods. A research method is a strategy of

inquiry which moves from the underlying philosophical assumptions to research

design and data collection (Myers, 1997). According to Benbasat et al. (1987), case

study research method is particularly well-suited to research of IT systems in

organizations especially because of the focus on organisational rather than technical

issues. Darke et al. (1998) argue that case study research is well suited to

understanding the interaction between IT innovations and organisational contexts.

Benbasat et al. (1987) provide three other main reasons for the suitability of the case

study research in investigating IT systems. Firstly, the research can occur in a

phenomenon’s natural setting. Secondly, how and why questions can be addressed

allowing you to understand the nature and complexity of the phenomenon. Thirdly

case studies allow investigation into areas where few studies have taken place.

There are no commonly accepted definitions of a case study (Myers, 1997), Yin

(1994:13) nevertheless defines a case study as “an empirical study investigates a

contemporary phenomenon within its real life context, where boundaries between

phenomena and context are unclear; contains many more interesting variables than

data points; relies on multiple sources of evidence with data converging to form

results and benefits from prior theoretical propositions to guide data collection and

analysis”. Eisenhardt (1989:534) additionally states that: “case studies typically

combine data collection methods such as archives, interviews, questionnaires and

observations. The evidence may be qualitative (e.g. words), quantitative (e.g.

numbers) or both”.

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According to Myers (1997) qualitative research involves the use of qualitative data,

such as interviews, documents and participant observation data to understand and

explain social phenomena. Case study research is the most common qualitative

method used in information systems research (Myers, 1997; Orlikowski & Baroudi,

1991; Alavi & Carlson, 1992). Quantitative research methods were originally

developed in the natural sciences to study natural phenomena. Examples of

quantitative methods now well accepted in the social sciences include survey

methods, laboratory experiments, formal methods (e.g. econometrics) and numerical

methods such as mathematical modelling (Myers, 1997). A qualitative analysis allows

on one hand allows for the thorough and holistic study of a phenomenon by seeking

the understanding of participant opinions. A quantitative analysis on the other hand

enables the data gathered to be expressed in a codified form. Statistical measurements,

comparisons and generalizations can be made. However, this approach is widely

accepted to be limited in the understanding of social processes. Kaplan & Maxwell

(1994) also argue that the goal of understanding a phenomenon from the point of view

of the participants and its particular social and institutional context is largely lost

when textual data are quantified. Examples of previous studies on KM in public

organisations that adopted a single quantitative survey method include Syed-Ikhsan &

Rowland, 2004a; Syed-Ikhsan & Rowland, 2004b).

Miles & Huberman (1994) state that if an exploratory study is to be conducted, the

parameters or dynamics of the social setting cannot really be known, therefore heavy

instrumentation or close ended data collection devices are inappropriate. Flick (1998)

further suggests that the use of multiple methods helps in securing an in-depth

understanding of the phenomenon under study.

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The exploratory nature of this study suggests that the most suitable research method is

of a qualitative nature. Researchers (e.g. Berg et al., 1998; Berg, 1999; Kaplan, 1997)

recommend that studying the use of IT in a medical context should involve empirical,

often qualitative studies to gather insight into the everyday socio-cultural processes

that constitute these practices.

However, several researchers (e.g. Lee, 1991; Gable, 1994; Gallivan, 1997; Markus,

1994; Majchrzak et al., 2000) have recommended combining qualitative methods with

quantitative methods to ensure that the richness afforded by qualitative methods is

supported by quantitative analysis. McAdam & Reid's (2000) study of public and

private sector perceptions and application of KM for example, employed a

combination of a research survey and participative workshops. This view is also

supported by previous studies on the evaluation of IT usage in a hospital setting which

have employed a combination of research methods. For example, Sayegh et al. (1999)

in investigating the impact of hypertext, Intranet and Internet technologies on usage of

pathways in clinical medicine utilized a combination of questionnaires and interviews.

Connell & Blandford (2004) in their study of Intranet usage frequency in a hospital

used a combination questionnaire survey and interviews.

This case study thus uses a combination of a questionnaire-based survey, face-to-face

interviews, strategic document reviews (e.g. Intranet log files and strategy

documents), personal observations, Intranet usage demonstrations and consultations

with relevant experts to ensure richness of data and proper understanding of the

context (Miles & Huberman, 1994). This approach ensured that the richness afforded

by the qualitative methods was supported with quantitative analysis. This exploratory

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case study also includes key elements of an ethnographical approach to research.

Harris & Johnson (2000) define ethnography as ‘a portrait of a people’. Multiple

sources of information are sought and used, as no single source of information can be

trusted to provide a comprehensive perspective (Patton, 1990). Ticehurst & Veal

(1999:104) describe that this type of research method draws on various techniques,

usually combining them. The use of multifarious data sources helped in validating and

crosschecking any findings and in evaluating the usage and impact of the Intranet on

knowledge sharing in the public hospital.

According to Myers (1999), ethnography is widely used in the study of information

systems in organisations, from the study of the development of information systems

(Hughes et. al, 1992; Orlikowski, 1991) to the study of aspects of information

technology management (Davies & Nielsen, 1992) and their impact (Randall et al.,

1999). Ethnography has also been discussed as a method whereby multiple

perspectives can be incorporated in systems design (Holzblatt & Beyer, 1993) and as

a general approach to the wide range of possible studies relating to the investigation

of information systems (Pettigrew, 1985).

Typically, a case study researcher uses interviews and documentary materials first and

foremost, without using participant observation. The distinguishing feature of

ethnography, however, is that the researcher spends a significant amount of time in

the field. Because the researcher is at a research site for a long time - and sees what

people are doing as well as what they say they are doing – an ethnographer obtains a

deep understanding of the people, the organization, and the broader context within

which they work. Ethnographic research is thus well suited to providing information

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systems researchers with rich insights into the human, social, and organizational

aspects of information systems (Myers, 1999).

Denscombe (1999) also adds that an ethnography approach enables the capturing of

social reality more so than other approaches to research. It allows for the gathering of

contextual data that are relatively rich in detail and depth rather than abstracting

specific aspects in isolation. This approach seeks to see the world through the eyes of

the participants, allowing them to speak for themselves through extensive direct

quotations. This research thus plans to employ an ‘impressionist’ style with the

researcher through the research methods adopted providing the opportunity for the

story’s key players to speak (Van Maanen, 1988:105). This enables an additional

backdrop for the interpretation of findings and the expansion of the knowledge

generated from the results to create a new, enhanced understanding of the situation

under study. Detailed information of the methods used in the three phases, the data

collection procedures as well as analyses is provided in chapters five, six and seven.

The reasons for the selection of the case study setting are presented below.

4.1.1 Sample Selection

Industry sectors that rely heavily on documentation and informatics to conduct their

business, as in the case of healthcare, are more likely to adopt IT tools such as the

Intranet (Welch & Pandey, 2003). As Berg (1998) explains, large modern hospitals

are highly specialized. They are characterized by state-of-the-art knowledge and staff

with high levels of education. They are also characterised by organisational

complexity as knowledge originates from a myriad of different contexts and

information sources. Large hospitals have subsequently become quite complex. Such

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large sizes lead to knowledge fragmentation as well as a difficulty in locating and

sharing knowledge thus creating a strong need for KM (Hislop, 2001).

A large hospital is therefore more likely to have the need as well as the resources to

implement an organisation-wide IT tool such as the Intranet to support KM. It also

provides a suitable and practical research setting for investigating and understanding

the dynamics involved in the relationship between the Intranet, key actors (e.g.

employees) and KM, particularly the processes of knowledge sharing.

Employees at the hospital also fit the definition of knowledge workers in that they are

highly qualified and educated professionals (Mood & Shanks, 1999). They are drawn

from a variety of skilled and professional backgrounds, key among them nursing,

medicine, clinical support, corporate administration, IT, maintenance support and

Allied health professionals. According to Gray (1999), Allied health professionals

include physiotherapists, occupational therapists, speech pathologists, dieticians,

clinical psychologists, pharmacists and social workers.

4.2 Overview of the Empirical Case Study

This section presents a broad description of the three different phases of the empirical

case study (a more detailed description is provided in chapters 5, 6 and 7). The first

phase of the research addresses the first research question. It provides background

information of the research setting (a large and ultra-modern public children’s

hospital) and the Intranet used. This involves a combination of interviews with IT

personnel, personal observations, usage and features demonstrations and a review of

key hospital documents such as annual reports, strategic plans and Intranet logs for

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gathering historical data on Intranet usage. This phase of the study aimed at

identifying and understanding the structure and operations of the hospital. It also

aimed to provide a detailed description of the Intranet used. Such as the Intranet type,

its technical specifications, its history and development, the various issues

encountered in its development, the influencing actors involved in its administration

as well as its numerous features and applications.

The second phase of the research explores the opinions of respondents towards

various issues related to the usage of the Intranet. An online questionnaire with a

combination of closed and open-ended questions was administered in this stage. The

aims of this phase of the study includes identifying the various types of Intranet users,

their Intranet experiences and patterns of usage, the type of knowledge processes the

Intranet is used for, other knowledge sharing sources and mediums used. It also

identifies the key issues faced by users in using the Intranet, including opinions on its

advantages and disadvantages. The research findings highlighted some of the key

issues to be investigated in the third phase of the study outlined below.

The third and final phase of the research investigates the important issues highlighted

in the previous phases using a qualitative approach involving face-to-face in-depth

interviews. It importantly investigates the role and impact of the Intranet on the

knowledge sharing represented by Nonaka & Takeuchi’s (1995) knowledge

conversion model. In addition, this phase of the study investigates the influencing

factors on the usage of the Intranet for knowledge sharing at the hospital.

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4.3 Measures to Ensure Integrity and Validity of the Research

4.3.1 Ensuring Internal and External Validity

Certain issues regarding the quality of the case study have to be considered to ensure

the validity and reliability of the study. Validity is the extent to which the data

collected truly reflects the phenomenon being studied (Ticehurst & Veal, 1999).

Threats to validity generally fall into two main groups, internal and external. Internal

validity refers to the extent to which conclusions can be drawn concerning the causal

effects of the independent variable on the dependent variable. External validity

however, refers to the extent to which results from the study can be generalized to the

‘real world’ (Judd et al., 1991). In addition to internal and external validity, Yin

(1994) outlines two other criteria for ensuring the quality of a case study. These

include: construct validity (developing measures for the concepts of the research) and

reliability (the extent to which the findings are replicable). These criteria were all

addressed in this case study.

To minimize threats to internal validity, the transcriptions of the interviews were

checked for errors and cross-checked with interviewee recordings to assess the

researchers’ account of the interview as suggested by Yin (1989). To minimize threats

to construct validity and external validity, no single source of data was relied upon.

Several different sources of data were used such as online questionnaires, face-to-face

interviews, website logs, Intranet features demonstrations, an extensive study of other

similar organisational websites to identify current practices, interviewing of industry

experts and many informal discussions held with academics in the related research

fields.

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Ammenwerth et al. (2003) point out that to address the problem of external validity,

the IT tool and its environment should be defined in detail. Miles & Huberman (1994)

explain that familiarity with the phenomenon and the setting under study is important

for instrument validity and reliability as they ride largely on the skills of the

researcher. The recording, transcribing and storing of all the data collected also allows

for the replication of the research. The different data gathered are grouped according

to their similarities. This minimizes threats to reliability and improves the quality of

the research (Kleining & Witt, 2001).

Additional measures were taken to better ensure the integrity of this research. These

measures are discussed in the following section.

4.3.2 Ethics Committee Approval, Data Security and the Researcher’s

Professional Background

There were a number of ethical concerns to be aware of regarding the research. The

research involved human beings. Therefore, the researcher must make the research

goals clear to the members of the organisation where the research is being undertaken.

Among other things, there is the need to gain the informed permission of the

respondents prior to their participation. It is also important to inform the respondents

that their names will not be revealed in the written report of the research and whether

they would like access to the results of the research. Informed consent to tape record

interviews was also obtained. Most of all, researchers must be sure that the research

does not harm or exploit those who have agreed to participate in the research

(Genszuk, 2003).

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While carrying out this research, this researcher addressed all the relevant ethical

concerns, adhering strictly to the Code of Ethics in place at the University of

Technology, Sydney (UTS) for conducting research. An ethics application form was

submitted for clearance to the UTS Human Research Ethics Committee and was

approved. Interviewees also had to sign consent forms which confirmed the

confidentiality of their views. Tape recordings of interviews and completed

questionnaires were stored in a secure location at the School of Management. Any

strategic and relevant information relating to the participating organisation, including

data and its sources, also remains confidential and was used solely for the purposes of

this research.

As pointed out previously, Miles & Huberman (1994) explain that familiarity with the

phenomenon and the setting under study is important for instrument validity and

reliability as they ride largely on the skills of the researcher. In the administering of

this study the professional work experience and skills background of this researcher

also contributed to the integrity, motivation and deeper understanding needed for the

carrying out of this study. The researcher’s work experience includes holding the

position of Consulting Project Manager (IT) at the Australian Derivatives Exchange

(ADX); as well as holding the Research Manager position at the International

Treasury Services (ITS) Pty Ltd. in Sydney, Australia.

The researcher is a member of the Australian Computer Society (ACS) and holds a

Masters in Information Technology as well as the Microsoft Certified Professional

(MCP) and Microsoft Certified Systems Engineer + Internet (MCSE + I)

certifications. The researcher is also currently a part-time lecturer for the Managing

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Knowledge subject at the School of Management, UTS. This research is a personal

journey into an intriguing area of research and this researcher strongly believes that

personal interest, skills, academic qualifications and experience have all helped in

providing the needed appreciation and deeper understanding of the IT tools as well as

the KM concepts and issues addressed.

4.4 Summary

In summary this chapter has provided an overview of the empirical research studies to

be conducted. It has also outlined the exploratory case study research method adopted

and provided justifications for its usage. It also presents the methodological

limitations that arise and how they are minimized. The additional measures to ensure

the integrity of the study and the addressing of ethical concerns are presented while

the provided facilities that aided the carrying out of the research were pointed out. The

following chapter provides a thorough description of the organisational context where

the research was conducted and the Intranet was used.

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Chapter 5-The City Hospital Intranet in Practice

(Phase One)


This chapter provides detailed background information on the research setting, a large

and ultra-modern public hospital in Australia (hereby referred to as the City hospital).

It provides an overview of the Intranet, describes its development, system

architecture, technical and non-technical issues encountered, hospital initiatives

developed, detailed hospital Intranet descriptions and the various applications it

provides. The results of this phase of the case study were combined with guidelines

already developed from the literature review, as well as personal observations in the

research setting. The results were also combined with the researcher’s familiarity with

the technology and the setting under study to inform the development of the online

questionnaire and an interview guideline as suggested by Patton (1990) for use in the

case study.

.

5.1 The Aims of the City Hospital Intranet Background Study

This aims of this phase of the research included gathering background information on

the City hospital and investigating the nature of the Intranet in use. This importantly

involved a review of the history and development of the Intranet. Another important

aim was to identify and investigate the Intranet type, its technical specifications and

features. It was also important to investigate what the goals and objectives set out for

the usage of the Intranet were at the City hospital and to identify the influencing

‘actors’ or people involved in the its administration. Ammenwerth et al. (2003)

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explain that such background investigation is important in a hospital to enable

motivation, support and increased participation in the study. This phase of the

research thus addressed the following question with the subsequent aims:


The aims of this phase included:

a. Investigating the type, technical specifications and features of the Intranet in

use at the hospital.




d. Investigating the goals and objectives set out for the usage of the Intranet at

the hospital.

5.2 Method

An extensive background study of the City hospital and Intranet was conducted with

relevant information about the City hospital (e.g. number of employees, bed capacity

and revenue) gathered from key documents such as strategy plans, press releases,

annual reports, Intranet logs and Intranet statistics. Senior IT managers at the City

hospital who administer the Intranet and were involved in its implementation provided

critical comments gathered from initial discussions regarding the history,

development and current status of the hospital Intranet. Intranet logs and statistics

were also used to gather historical data on Intranet usage. It is important to point out

that personal observation, usage and features demonstrations were an important part

for gathering data on the City hospital Intranet in this phase of the study.

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According to Patton (1990) no single source of information can be trusted to provide a

comprehensive perspective. The use of multiple data sources assisted in validating

and crosschecking any findings and in evaluating the usage and impact of the Intranet

on knowledge sharing in the selected organisation. The use of many different sources

of data as supporting evidence is also a major strength of the case study method.

According to Yin (1989), a case study is likely to be much more convincing and

accurate if it is based on several different sources of information. To provide support

to the analyses, informal discussions and consultations with industry

experts/professionals and academics in fields related to this study were undertaken

throughout the duration of the research to reinforce and gain an in-depth

understanding of the data gathered. An extensive online study of other similar-sized

public hospitals was carried out to identify current Intranet practices, providing

supporting evidence to strengthen the validity and reliability of the research.

5.2.1 City Hospital Facilities Provided

It is important to mention that in the course of this research, this researcher was

provided with several aids and access to certain facilities at the City hospital. These

included a 24-hour City hospital access pass, an office desk, an official City hospital

telephone number and an official City hospital E-mail address. Additionally, this

researcher was given a tour of the City hospital, introduced to key people and was

able to attend some key meetings. The researcher was thus able to be totally immersed

in the research setting by being an informal participant observing and enquiring. This

provided the researcher with a secondary source of information that ultimately added

to the richness in understanding and analyses of the issues being investigated.

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5.3 Overview of the City Hospital

The City hospital is a major public children’s hospital in Australia and an

international leader in child health, working at the cutting edge of paediatric services,

research and teaching. With over 46,000 patients admitted to the City hospital every

year, it has a 339 bed capacity, an onsite hostel and is also a teaching hospital

affiliated with the medical school of a major university thereby providing the means

for medical education. The vision at the City hospital is to provide:

Better health for children

Excellence in child healthcare

Its stated mission is to: ‘Constantly challenge the existing boundaries in paediatrics

and child health by leading change and striving for excellence in clinical care,

research, teaching and advocacy’.

The City hospital is a leading public hospital that is highly focused on achieving and

maintaining its organisational goals of high standards of patient care and services. It is

at the forefront of implementing various initiatives that support the achievement of

these goals and objectives. IT tools and services have played a vital role not only in

the core medical services provided, but also from the perspective of overall

organisational efficiency and effectiveness. The organisation is viewed as fitting the

definition of a knowledge organisation. It delivers services and users its knowledge

and expertise to solve complex problems for its customers/patients (Moody & Shanks,

1999). The City hospital as the defined research setting for this study provided an

ethnographically rich context to investigate the usage of the Intranet for knowledge

sharing as well as the enabling organisational conditions.

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5.3.1 Organisational Structure and Lines of Responsibility

The City hospital can be viewed as one with parallel yet overlapping structures (as

seen in Figure 5.1 below). The clinical and medical areas function separately and

relate independently to senior management. However, the nursing, finance and other

support areas report along different lines of the management hierarchy.

Figure 5.1: City Hospital Organisational Structure and Lines of Responsibility

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5.4 Overview of the City Hospital Intranet

5.4.1 History and Development

The City hospital IT mission is stated as enabling: the right people to have the right

information at the right time in the right place to ensure the delivery of high quality

services. The objective of the Intranet as stated by the Senior IT Manager at the City

hospital is about: “getting the right information to the right people at the right time in

the right format to enable the right action”. The quote represents the key outcome of

any successful KM initiatives in any organisation. In view of this strategy, the City

hospital Intranet was first launched in 1996 and was initially maintained by one

dedicated webmaster. As the deputy IT manager at the hospital pointed out: “we had

around 1200 PCs at the time”. At the time of this study however there were

approximately 2000 workstations across the site and in distributed locations with

approximately 2095 members of staff. While all staff may not necessarily need to

have their own PC due to the particular nature of their jobs, all have individual access

(username and password) to the workstations and the City hospital Intranet. There are

also two senior web developers and two dedicated website administrators, including

several technical support staff providing IT development and technical support to

Intranet users.

The initial Intranet was built and developed in-house on Linux and Apache servers

using Perl programming language scripting. The City hospital IT developers utilised a

product called HTML Transit to convert Microsoft Word documents to HTML with

HTML transit currently being used. According to an IT administrator, at that time the

Intranet included approximately 1000 web pages in size and was growing rapidly.

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The growing size of the Intranet coupled with user needs for more sophisticated

medical applications, software and computing needs led to the development of a new

and larger Intranet. The initial development of the Intranet involved the

implementation of a dynamic system of desktop management; including the rollout of

Microsoft Windows 95 to all personal computers in the Hospital and the extension of

the Helpdesk Services to provide seven-day support to users. As at the time of this

study, desktop management front end had been upgraded to Microsoft windows XP

and Novell-delivered applications for customising the applications that employees use

(e.g. Powerchart program). The platform inter-operability of the City hospital Intranet

means it was able to run on a combination of platforms largely Novell based,

including Microsoft and Linux Unix servers.

5.4.2 Addressing Resistance to the City Hospital Intranet

Despite its seamless functional benefits, the City hospital Intranet presented a

significant change in work methods for the healthcare professionals at the City

hospital. It required users to spend more time becoming familiar with its features and

applications in an environment where time is crucial.

According to the Senior IT manager, the initial reaction of staff members consisted

largely of inaction and lack of interest, for example when medical doctors did not

participate in the training sessions and put little effort into learning to use the Intranet.

Apart from the time constraint issues raised, some of the older medical doctors were

uncomfortable with IT tools in general and felt that learning about the City hospital

Intranet functions was unnecessary and not beneficial to their daily work.

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The IT department held meetings with key users and several issues were identified.

The issues that arose with the decision to implement the City hospital Intranet could

be categorised as technical and non-technical barriers. However, there were some

issues that overlapped between these two categories. There was a need, therefore, to

address both these technical and non-technical issues that had become prominent in

the design, development, implementation and usage of the City hospital Intranet.

Discussed below are descriptions of the some of the key issues identified and the

initiatives developed to address them in the lead up to the development of a new City

hospital Intranet.

5.4.3 Overcoming Technical Challenges

Technical impediments refer to problems related to the use of the Intranet itself such

as inadequate or wrong software, poor features, bad navigational structure and limited

functionalities (Geisler & Rubenstein, 2003). To cope with the growing size of the

hospital and various user needs, the City hospital Intranet needed a more developed

and integrated architecture than previously used. As shown in Figure 5.2 below, a new

Intranet architecture was developed.

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5.4.3.1 The New City Hospital Intranet Architecture

Figure 5.2: The New City Hospital Intranet Architecture

The new City hospital Intranet was built upon the PHP (Hypertext Preprocessor)

scripting language. PHP is a server-side, cross-platform HTML embedded scripting

language that allows the developer to create dynamic web pages. PHP-enabled web

pages are treated in the same way as regular HTML pages and the developer can

create and edit them in the same manner as regular HTML. PHP Scripting language

runs on Apache data service with the bulk of it coded by the hospital’s senior web

developers.

The next version of the Intranet was subsequently built on Linux Apache MySQL

PHP (LAMP). As Dyer (2005) explains, LAMP is used to define how a multi-user

database management system, MySQL is used in conjunction with Linux, Apache

servers and either Perl or PHP scripting languages. LAMP represents an open source

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web platform and most importantly it is a solid and reliable platform of choice for the

development and deployment of high performance web applications.

The City hospital currently maintains a standard environment using Microsoft

Windows NT (New Technology), Windows 2000 and Windows XP (eXtended

Professional) operating systems. Ghost software is used to ‘re-invent’ machines with

the operating system and a standard setup. Desktops are leased over a three year

period — this allows for the desktop infrastructure to be refreshed with appropriate

technology — without the need to present business cases and struggle for funding.

The underlying architecture of the new Intranet consists of a Software Virtualization

Solution (SvS) Trace. A SvS Trace monitors the security event logs of all Windows

NT/2000/XP servers and workstations. The software alerts the administrator of

possible intrusions and attacks. It also backs up all selected security event logs in a

centralised MySQL database. Within that context a Content Management System

(CMS) was built making use of Lightweight Directory Access Protocol (LDAP)

authentication for users. This enables the management of information currency on the

Intranet that now allows authorised users to be automatically alerted when their

content has or is about to expire.

File and print services on the Intranet are maintained by Novell and therefore a Novell

Directory Services (NDS) Login is the primary control method for users to gain

access to the environment. When users login to the NDS, their access is governed by

their belonging to a particular department (Organisational Unit) and through

membership of nominated groups (e.g. workgroup, committees). Among other

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functions, login scripts maintain standard drive mappings (or shares) as the user logs

in or authenticates. Novell Directory Print Services (NDPS) allows users automated

printer delivery and access to networked printers.

The new Intranet also makes use of the application delivery component of Novell’s

ZEN (Zero Effort Networking). ZEN is a directory-enabled service for workstation

administration that significantly reduces the costs associated with managing

networked PCs. This allows website administrators to maintain the most up-to-date

programs without physically visiting every machine. The delivery component of

ZEN-Netware Application Launcher (NAL) uses push technology to allow users

access to applications. Nearly all applications are delivered via NAL. This is one of

the strongest aspects of the desktop management processes at the City hospital and

has been in place since 1995. Other components of the ZEN that are utilised are

desktop remote control and inventory services. Remote control is used to support

users while WebTrends Log Analyzer software is used to provide usage and other

statistics related to the City hospital Intranet.

5.4.3.2 Accessibility and Usability

Accessibility was considered a major challenge because as the deputy IT manager

mentioned, “the proper usage of the Intranet was directly connected to it”. There was

the need to ensure that there was a sufficient PC population and necessary

infrastructure to provide access to the Intranet in the various departments/units of the

City hospital. In this context, not providing proper access would mean hampering the

healthcare delivery and the placing of lives at risk. Additional computers were leased

on a three year basis to keep up-to-date with new developments and allow for

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upgrades. Access to the Intranet was made available 24 hours a day, seven days a

week.

It was also important to ensure that the Intranet was easy to use and navigate.

Usability can be defined as the effectiveness, efficiency and satisfaction with which

users can achieve tasks in a particular environment (Ginsburg & Pusedu, 2001). High

usability means a system is easy to learn and remember, efficient, visually pleasing,

fun to use and quick to recover from errors (Ginsburg & Pusedu, 2001).

Layout and ease of use are considered important usability factors (Begbie & Chudry,

2002). Feedback was sought from the users as to the look and feel of the new Intranet.

It was agreed that a standard template, structure and appearance be developed across

the entire City hospital Intranet. As a web developer explained, it was also necessary

to have a common layout across the different departments/units as this would make

navigation easier (see Figure 5.3 below for an example of a department page on the

City hospital Intranet). While the writing and publishing for the departmental/unit

websites on the Intranet would be decentralised, the layout would be standardised. At

the beginning of this study however, issues had arisen including for e.g. the need to

present information on certain sites that users in those department/units felt would not

suit the standard layout. These issues are investigated the subsequent phases of the

research.

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Figure 5.3: Example of Department Page on the City Hospital Intranet

5.4.3.3 Security

The senior IT manager involved in the implementation of the new City hospital

Intranet remarked that security was a major concern. There was therefore a need to

ensure security and confidentiality of the City hospital content and this underlined the

approach adopted in the development of the new Intranet. The City hospital Intranet

developers had to identify the type of information to be placed on the Intranet, the

different needs of each category of users as well as determining the level of security

required. A password synchronisation process was implemented using Lightweight

Directory Access Protocol (LDAP) and Netware directory services. LDAP is a

protocol definition for accessing specialised databases called directories. It is used by

E-mail programs to look up contact information from a server. LDAP authentication

for users allows for synchronised password access to Internet and Intranet resources

such as E-mail. This means that users maintain the same login for the Intranet, for E-

mail as well as for their initial computer system (NOVELL) login. This allows the

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synchronisation of username and passwords on multiple systems, thus improving user

satisfaction and increasing productivity.

According to Al-Gharbi & Alturki (2001), security is important especially when

dealing with sensitive information. Cavalli et al. (2004) define information security

classically as the preservation of:

Confidentiality: ensuring that information is accessible only to authorised

people;

Integrity: safeguarding the accuracy and completeness of information and

processing methods;

Availability: ensuring that authorised users have access to information systems

when required.

5.4.3.4 Maintenance and IT Support

Another important requirement according to the senior IT manager was the need to

have adequate resources and staff to provide the required ongoing maintenance and

support for the City hospital Intranet. This was placed under the responsibility of one

major department (the IT department) and two units in the hospital directly linked to

its management, namely:

o The IT trainers unit;

o The Clinical Application Support Unit (CASU).

The IT department consists of the IT director, IT manager, Deputy IT manager, two

senior website administrators, senior and junior web developers and several technical

assistants. The Intranet management team includes the IT manager, the deputy IT

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manager, two senior website administrators, senior and junior web developers and

several technical assistants responsible for the day-to-day management of content for

the City hospital Intranet. The IT department also monitors and provides technical

support for the IT infrastructure at the City hospital. Figure 5.4 below shows the IT

support link on the City hospital Intranet. IT service procedures were expanded to

provide priority support to clinically oriented ‘help desk’ calls and requests from

patient care and administrative areas. The IT department also encouraged staff to

contact them directly if they had questions or problems and provided extensive

support through training, tips and desktop/laptop computer purchases.

Figure 5.4: IT Support Page on the City Hospital Intranet

According to a senior web administrator, in maintaining the quality of the City

hospital Intranet, content provided “had to be current to avoid expired and irrelevant

backlog of information”. While this involves document versioning software and is the

responsibility of the individual departments/units, the website administrators also

supervise the current content and provide E-mail reminders to the relevant

departments/units. Communication between the Intranet management team and

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departments/units including general users is mostly done on a one-to-one basis by E-

mail or telephone. There are also ad hoc visits by the IT staff to the various

departments/units. The weekly communiqué E-mail update helps with general

information and enquiries. Furthermore, quick reference Frequently Asked Questions

(FAQ) knowledge bases for common queries were developed online and are

continuously updated to save time.

The dedicated IT trainers unit run regular training sessions on the use of clinical and

non-clinical applications in the City hospital. The Clinical Application Support Unit

(CASU) is a unit within the Division of Information Services, established to provide

expert knowledge and support to users of clinical systems. Also included in the

division are the departments of IT, Medical Records and the hospital Switchboard

(See Figure 5.5 below for service links on the Division of Information Services page

of the City hospital Intranet). Whilst the IT support staff focus on assisting computer

users with technical issues involving computers, printers and applications including

Microsoft Office tools, the CASU staff focus primarily on the clinical and related

applications. These clinical applications include PowerChart, Discharge Summary,

Patient Management, Scheduling, Tracking and Coding.

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Figure 5.5: Example of Service Links on the Division of Information Services Page on the City Hospital Intranet

The staff members that make up CASU come from a variety of backgrounds,

including among others clinical, nursing and financial. The skills mix and experience

of the CASU staff enable them to support staff from many different areas, as they

understand the roles of the staff they are liaising with. In many cases as discovered,

they have worked in similar capacities and have a solid understanding of systems and

work flow.

A unit of the City hospital that is also involved indirectly in managing the Intranet is

the Service Improvement Unit (SIU). The SIU’s role is to coordinate improvement

efforts across all areas of the hospital to ensure that the highest possible quality and

safety of care is being provided. The SIU uses the City hospital Intranet to provide

leadership in, and education and support for the continuous development of all staff in

order to facilitate the pursuit of excellence in child healthcare. The SIU publishes

various reports on the Intranet. For example, reports for improvement projects are

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published on the Intranet to help standardise and facilitate the sharing of improvement

information across the City hospital. The electronic improvement database also made

it easier for staff to document their improvement activity and also see what other

departments/units are doing.

Educational programs were developed by the SIU on planning, continuous

improvement, specific clinical practice improvement methodologies, project

management and working in partnerships with others users. All education programs

developed were also easily accessible on the City hospital Intranet making it the

central knowledge resource point for staff. The SIU includes skilled computer

programmers with backgrounds covering: nursing management; finance; medical

records; IT support and training in administrative and clinical systems; health

information management; and computing and information systems. These application

specialists have a detailed knowledge of the main business processes of the City

hospital and are well qualified to support these applications.

5.4.4 Overcoming Non-Technical Challenges

Non-technical challenges refer to the non-technical aspects that act as barriers to the

usage of the system (Geisler & Rubenstein, 2003). Described below are some of the

key non-technical challenges identified and initiatives implemented to address them.

5.4.4.1 User Involvement

Due to the reluctance of some of the staff members at the City hospital, especially

doctors to use the Intranet, the IT staff responsible for its development sought

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feedback from staff members. The consultations, the deputy IT manager stated, were

“crucial because users got involved in the new designs and development of the new

Intranet”. This also allowed for the airing and addressing of any concerns or

misgivings that users might have. User feedback was important in making Intranet

developers aware of the key concerns users from different job functions in the City

hospital may have regarding the organisation, structure, content, navigation and the

general look and feel of the Intranet. Al-Gharbi & Alturki (2001) citing Gonzalez

(1998), stress the need to have users involved in the design, development and

implementation of the Intranet. This important in order to increase user satisfaction

and to avoid the counterproductive aspects of the traditional method where IT

specialists do every thing in isolation and deliver a ready system to employees to use.

This was especially important as its success was dependent on wide support,

especially from the main work groups e.g. nurses and clinicians.

5.4.4.2 IT Contacts

A web-steering committee was formed with IT ‘contacts’ appointed from each

department/unit to meet regularly and work with the IT department. In conjunction

with the webmasters and IT managers, this committee provided an opportunity for

continual feedback, to pass on the IT needs and requirements of the departments/units

in the event of IT projects and to offer advice on content priorities. It was also an

opportunity to share best practice and participate in Intranet quality assurance

processes. IT contacts were trained in the usage of the writing/creating tools and

publishing the information content on to the sites on the City hospital Intranet without

having to go through the web administrators. IT contacts were also responsible for the

accuracy and currency of the information provided on their Intranet sites although this

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was also monitored by the web administrators in the IT department. This decentralised

form of control was meant to give the department/units providing the information a

sense of ownership. Lamb & Davidson (2005) concluded that mixing the roles of

content owners, developers, and users allows for the IT tool to be applied and adapted

for local context usage and is an important ingredient for success. Miller et al. (1998)

explain that a corporate-wide committee responsible for policy and strategy

development is helpful in setting overall strategy, allowing for the devolution of its

implementation to specific website groups. Rosen (1998) also showed how Microsoft

used ‘evangelists’ in strategic groups to inform employees that the Intranet was the

new medium for sharing information.

5.4.4.3 Training

The development and usage of an Intranet in an organisation allows employees,

departments/units and functions to become information/content providers and

managers. If the Intranet is to be of any benefit to the organisation, its users would

require among other things, training in publishing tools, security and confidentiality

procedures, archiving, document management and design. Comprehensive IT training

provided for users ensures that healthcare professionals and patients receive

maximum benefits from the Intranet. The opportunity for training is one of the key

aspects contributing to the end-user’s satisfaction (Costa et al., 2004). The IT

department therefore assembled a dedicated unit of trainers to run scheduled training

programs throughout the year. Training programs covered several areas including the

usage of available applications on the City hospital Intranet, authoring and publishing

tools. For example, this included how to broadcast lectures to medical students in

geographically dispersed locations using videoconferencing connections and thereby

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effectively reducing previous call costs to zero. Moreover, mandatory training could

now be extended to the night shift staff via the Intranet.

Figure 5.6: Education and Training Page on the City Hospital Intranet

Figure 5.6 above shows a sample page of the education and training site on the City

hospital Intranet. Other examples of training programs provided include videos on the

Intranet of the ‘grand rounds’. Grand rounds is the term used to refer to consultants,

clinicians, allied health professionals and students walking around wards with senior

doctors sharing their knowledge on the patients in highly interactive presentations

(Tarala & Vickery, 2005). A further example is the online provision of training on the

usage of e-learning software to develop a model for educating nursing staff

concerning safe medication for children. These and other flexible learning programs

provided staff with the basic skills to benefit clinical and general staff in the usage of

the City hospital Intranet.

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5.4.4.4 Ensuring Quality

The web-steering committee and assigned IT staff needed to ensure commitment to

quality in order to maintain the usage of the City hospital Intranet. This was achieved

through the collaboration between IT contacts nominated in the individual

departments/units that made up the web-steering committee and the web developers.

The IT contacts informed the web developer of their quality issues and concerns with

regards to the information published on the Intranet. This led to the development of an

agreed set of standards.

A key quality concern was the need to maintain the integrity of the information on the

Intranet, which is also part of information security. This meant that the accuracy and

topicality of the information had to be guaranteed. To this end, information providers

and publishers had to demonstrate their commitment to keeping information on the

Intranet up-to-date. To ensure the integrity of the information published, authors of

published reports or documents including general website information were instructed

to provide their contact details along with both the dates of content created and the

needed updates, if any. Additionally, a software system to monitor document versions

and expiry was implemented. The authors were automatically notified when the

content published required updating and were notified that there was a need to update

or remove particular content. This was essential to enable trust in the information

presented. The use of versioning and document expiry notifications on the City

hospital Intranet was therefore able to keep information relevant and up-to-date. This

feature allowed document authors to actually age them. It also made maintaining them

easier and helped the system automatically maintain only the most current

information.

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As Espinosa (1998) maintains, poor quality data can have a detrimental impact on the

perception of health data availability and on its usefulness for healthcare professionals

and policy makers. Data that are of poor quality, in an antiquated state, or of low

relevance will increase uncertainty in information generated and decrease the

reliability of decisions made from the system. The standards agreed to were therefore

more than justified.

5.4.4.5 Ensuring Access

The City hospital Intranet was developed to provide immediate access to a range of

network services with quick links to a gamut of resources. These included various

clinical applications, knowledge bases, clinical policies and procedures, online

training videos, software and education resources, HR resources, rosters, IT support

resources, online managerial support tools, cafeteria menu, stores, hospital news and

updates, an internal phone directory, paging facilities, switchboard and E-mail

services. It also offers links to an online library, ‘what’s new and happening’ in the

form of regular updates, a site map, Intranet feedback, search functions and external

links to the Internet and the primary regulatory body, the New South Wales

Department of Health (D.O.H).

5.4.4.6 Senior Management Support

In order to show the importance of the City hospital Intranet and to provide the

necessary support in terms of resource allocation, it was critical that senior

management at the City hospital championed its development and usage. The deputy

CEO and IT director of the City hospital stood out as key influential ‘champions’ of

the Intranet. The clinical background of the deputy CEO also played an important role

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in securing the commitment of influential clinical staff at the City hospital. Senior

management were seen to be eager to publicise the introduction of the Intranet and

marketed it extensively. This was evident in the frequent references to the Intranet in

the various hospital news and related publications. This was also accomplished via E-

mails, all user weekly communiqués (summaries of latest City hospital directives sent

by E-Mail and available on the Intranet), staff orientation presentations as well as at

hospital talks and conferences. Senior management encouraged each department to

conduct similar marketing efforts for their own sites among their staff members.

5.4.4.7 IT Strategy

The IT department in consultation with the web-steering committee and other key

stakeholders considered it critical that the implementation of the Intranet was aligned

with the aims and objectives of the City hospital as encompassed in the IT strategy.

An IT strategy was developed to support the overall strategic direction of the City

hospital and New South Wales D.O.H. In 2004, an overarching national change

management strategy ‘HealthConnect’ was initiated to improve safety and quality in

healthcare by establishing and maintaining access to the collection, management and

distribution of electronic health information products and services for health care

providers and consumers. The strategy was a partnership between the Australian,

State and Territory Governments. It aimed to leverage E-health systems in different

parts of the health sector through a common set of standards so that vital health

information can be securely exchanged between health care providers such as doctors,

specialists, pharmacists, pathologists and hospitals and so on.

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The City hospital IT department mission statement was developed and outlined as

enabling the right people to have the right information at the right time in the right

place in order ensure the delivery of high quality services. The IT department also

initiated an education, training and development plan to improve the skills and

competencies of City hospital staff in the usage of the Intranet. The strategy was

closely aligned with the adoption of a service improvement focus and balanced

scorecard approach as a means of ensuring successful alignment and implementation

of the broader hospital strategy. Developing a balanced scorecard approach was

necessary to ensure a link between the hospital's strategic goals and outcomes. While

the goals and objectives developed could be linked to KM, there was however no

clearly outlined KM Strategy to guide the implementation and usage of the City

hospital Intranet. Rather, this was placed rather under an IT strategy framework.

5.5 The City Hospital Intranet Evolves

Statistics for the new City hospital Intranet reveal that it currently holds more than

6065 Intranet webpages and documents. The Intranet home page is the start-up page

displayed on all PCs available to City hospital staff (see Figure 5.7 below for entry

page of the City hospital Intranet). Staff members can access the content on the City

hospital Intranet by drawing on five main categories; patient information, clinical

information, employee information, clinical support, management and regulatory

information. The City hospital Intranet is integrated with employee workflow and is

focused on job support.

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Figure 5.7: Entry-Page of the City Hospital Intranet

The upgrade to the new City hospital Intranet means it is currently linked to over 129

hospital units, departments, institutes, centres and work group, from the hospital radio

station and volunteer units to its nuclear medicine and surgical units (see Figure 5.8

below for a sample page of linked departments, units, institutes and centres). This has

resulted in significant cost savings. For example, the implementation of a document

imaging system in order to enhance the electronic health records and enable clinicians

to view complete medical records online led to a saving of $500,000 per year on

microfilming and other associated costs. Another advantage of the City hospital

Intranet is its ability to facilitate accessibility and convenience through the release of

City hospital ‘triage’ videos. This enabled on-site and non-metropolitan nurses access

to educational resources otherwise only available in a metropolitan teaching hospital.

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Fig 5.8: List of Linked Departments, Units, Institutes and Centres on the City Hospital Intranet

5.5.1 Usage Level

In terms of the usage levels of the Intranet, Intranet logs showed that the greatest

proportions of users visit the Intranet over 10 times a day. There have been over 36

million hits on the new City hospital Intranet since its introduction in 2003, with over

70,000 average hits per day. Thus it appears that the Intranet has succeeded in

becoming a tool used on a daily basis throughout the hospital. Figure 5.9 below shows

the number of users of the City hospital Intranet at the time of the study.

0

500

1000

1500

2000

2500

Number of Users

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Number of Hours

Figure 5.9: Number of Users and Hours Spent on the City Hospital Intranet

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5.5.2 Communication and Collaboration

The City hospital Intranet acts as the primary source of corporate knowledge, serving

business, critical and patient care functions and linking to various internal and

external knowledge bases. It provides the hospital with a unique opportunity to

incorporate this knowledge into its existing systems and structures. The City hospital

Intranet supports various functions that could assist users in capturing, sharing,

storing, presenting and potentially creating new knowledge. Applications provided on

the City hospital Intranet include E-mail and calendar services accessed through the

Microsoft Exchange/Outlook E-mail system, providing access to other productivity

tools. This increases productivity of staff through improved access to better

technology. Figure 5.10 below displays a sample page on the Intranet where links are

provided to various groups, committee and project reports. This enables the sharing of

best practices or target work standards, prevents the duplication of effort and ensures

the building of consistent processes.

Figure 5.10: Example of Groups, Committees and Projects Page on the City Hospital Intranet

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Regular updates (see Figure 5.11 below) are also provided on the City hospital

Intranet to users via the all-user weekly communiqués, various news letters, as well as

the very popular gossips and grumbles site on the City hospital Intranet.

Figure 5.11: Regular Updates Link on the City Hospital Intranet

A popular communication feature of the City hospital Intranet is the online paging

facility. While not to be confused with the doctor paging system available in many

hospitals, this facility though similar, allows staff members to search and send

messages to each other via the Intranet and to several devices. These include phones,

pagers and wireless handheld devices such as Personal Digital Assistants (PDA)

leading to the mobile use of health information. Research publications are also

available online such as fact sheets that provide information to aid decision making.

Various knowledge bases (e.g. a web-based database for diseases) have also been

implemented on the City hospital Intranet. This means the healthcare staff will have

the best information available to advise families with regards to the future health

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issues of affected patients and their associated risks. Figure 5.12 shows an example of

a paging page.

Figure 5.12: Example of Paging Page on the City Hospital Intranet

The City hospital Intranet includes various online forms as shown in Figure 5.13

below to facilitate fast user-request management. For example, procurement forms to

facilitate billing, payment transactions and operational items procurement.

Figure 5.13: Example of Forms Page on the City Hospital Intranet

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5.5.3 Integrated Applications

5.5.3.1 Clinical Applications

There are various task-related clinical systems and applications linked through the

Intranet (see Figure 5.14 below for sample page of clinical IT applications) at the City

hospital. Some of these include:

AHMIS — Allied Health Management Information System

CCIS — Intensive Care System

CIAP — Clinical Information Access Program

Health-e-Care — Emergency System

Inpatient Summary — Discharge Summaries

KRONOS — Staff roster System

ORSOS — Theatre System

Pathnet (Classic) — Pathology Laboratory System

Patient Management — Patient Administration System

PowerChart — Hospital Electronic Medical Record (eMR)

Scheduling — Outpatient Appointments

Stocca — Pharmacy System

Figure 5.14: Example of Clinical IT Applications Page on the City Hospital Intranet

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Outlined below are brief descriptions of the major clinical systems used on the

Intranet adopted from City hospital documentation.

5.5.3.1.1 CIAP

The CIAP (shown in Figure 5.15 below) is an online, web-based evidence retrieval

system allowing clinicians to gain access to clinical databases to support evidence-

based practice, 24 hours a day at the point-of-care (Ayres & Wensley, 1999). The

CIAP allows for the placing of all the available literature in one location (Metcalfe et

al., 2001). It also provides access to a range of online medical resources including:

Medical Literature Analysis and Retrieval System Online (MEDLINE), The

Cumulative Index to Nursing & Allied Health (CINAHL) database, online journals,

pharmaceutical databases and online textbooks. A defining feature of the CIAP

initiative is the recognition that clinical evidence should be available to all healthcare

professionals, including allied health staff, close to where they treat patients (Gosling

& Westbrook, 2004).

Figure 5.15: CIAP Entry Page

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5.5.3.1.2 PowerChart PowerChart is the computer application used on the City hospital Intranet to access

electronically stored medical records of all inpatients or eMR (Electronic Medical

Record). The eMR is a system that provides clinical information for patient care and

treatment via a computer. In earlier times, a written medical record was kept to

document the care given to a patient and thus to facilitate continuity of that care. The

entries in the medical record enabled the medical doctor to recall previous episodes of

illness and treatment. Recently, however, medical records have been increasingly used

for other purposes ranging from providing a data source for billing the patient to

performing epidemiological studies and performing quality control in defending

against legal claims (Van der Lei, 2002).

The eMR at the City hospital provides a range of benefits to patient care, from rapid

access to information during clinical consultation itself. It allows instant access to a

comprehensive picture of an individual’s health history, cost savings associated with

better access, accurate and timely information enabling much more accurate diagnosis

and a reduction in costly medical errors. PowerChart is the core information system

that captures information generated by the clinician to document the care process

from admission to discharge. Current medical record data available include access to

patient demographic information, visit history, laboratory and radiology results, allied

health referrals, discharge summaries and outpatient letters, echo reports, growth chart

data and emergency visit summaries. Each patient's medical record is instantly

available online and various displays regarding the patient's status are placed at the

care giver's fingertips. Powerchart thus provides an integrated infrastructure for quick

access to patient information enabling more efficient patient management. The

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additional implementation of a document imaging system at the City hospital helped

to enhance and enable the viewing of complete medical records online by medical

doctors.

5.5.3.1.3 Patient Management

The Patient Management system is used for admission, waitlist, discharge and bed

management functions. Information collected on all patients is based on the standards

of identification developed by the Australian Department of Health. The system has

been customised at the City hospital to reflect the business processes and rules that

guide valid data entry. A feature called ‘Bedboard’ provides a visual display of

patients and beds. Its purpose is to enable wards to maintain an on-line census by

updating patient transfers and discharges on the system and replace the manual

procedures. Patient Management is integrated with PowerChart, Scheduling and the

Medical Records applications (Coding and Tracking). With an electronic Patient

Management System available on the Intranet, clinicians now have improved access

to patient information, including both in-patients and patients on waiting lists.

5.5.3.1.4 PathNet

PathNet is the pathology laboratory system used at City hospital and is linked with

PowerChart and Patient Management systems. Orders are entered electronically by

the clinicians into PowerChart and an electronic message is sent to PathNet. When the

laboratory completes the test, the results are then available through PowerChart for

clinicians to view. Updated patient demographics are sent to PathNet from Patient

Management ensuring all systems are synchronised with the most recent information.

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5.5.3.1.5 Inpatient Summary

The Inpatient Summary (also known as the Discharge Summary) is a system that

produces a document at the completion of an inpatient stay by the attending doctor

which is then viewable in PowerChart. The purpose of the Inpatient summary is to

highlight to the patient's paediatrician, the purpose of the admission, results of tests

and recommended follow-up care. Information on the Inpatient summary may

include: allergy information, immunisation details, principal diagnosis, other

diagnoses, medical history, examinations, investigations, medications and follow-up

recommendations.

5.5.4 Human Resources Department

The Human Resources (HR) department plays a key role among all the

departments/units in the City hospital. HR help in managing the staff numbers and

skills mix. This role is especially important as the Australian public healthcare sector

is currently suffering from a chronic shortage of staff and public hospitals have a high

staff turnover. The HR department uses the City hospital Intranet to keep staff

informed of important HR issues in the organisation while also serving individual

employment related queries. As shown in Figure 5.16 below, users can have

immediate access to personal data and carry out basic processing tasks related to

salaries, benefits, job vacancies, leave matters, employee development programs,

childcare facilities etc. Staff members can also submit HR forms online, saving costs

and time related with paper processing.

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Figure 5.16: Employment Links on the City Hospital Intranet

The employment link on the City hospital Intranet also includes a link to the e-Recruit

software application. This helps managers and enhances the staff recruitment process

by producing savings for the Hospital. It helps track all aspects of managerial

administration, including for example personnel management, health and safety

training and development.

Figure 5.17: E-Manager Page on the City Hospital Intranet

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5.5.5 Finance Applications

The City hospital Intranet provides staff with secure access to financial applications.

Figure 5.18 below displays how the purchasing aspect of financial operations can also

benefit from the Intranet. The ‘NetXpress’ and ‘Smart buy’ features of the Store link

on the City hospital Intranet provide staff with a secure and easy-to-use electronic

purchase ordering system. The City hospital is thus able to simplify the purchasing

and payment of goods and services. It provides the ability to order and control

purchasing electronically, while eliminating paper processing costs and saving time.

Figure 5.18: Stores Link on the City Hospital Intranet

5.5.6 Operational and Managerial Reports

There are a large number of reports that have been designed to provide information

for operational and management requirements. Multiple users also have varying needs

for the information in these reports. Some examples are: ward clerks require a current

list of inpatients each day; the medical records department require clinic lists for

record retrieval; the outpatients department require patient lists for each clinic; patient

administration uses reports to check for missing Medicare numbers; the finance

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department needs discharge lists; while Nursing staff use reports to check whether a

patient has an expected date of discharge entered. These reports are available on the

Intranet giving the multifarious users the required access in the required formats

necessary for carrying out their jobs. HR features that were accessed across the

hospital included policies and benefits, payroll, job vacancies and postings, career

development and training. The Intranet allowed for the continuous update of these

crucial knowledge bases and gave employees across the hospital access to them.

5.5.7 Support Services

Numerous other departments, such as the food services, cleaning and hotel services

and PR have also shifted over paper-based forms, policies and transactions to the City

hospital Intranet. Thereby allowing the information created to be shared across the

hospital. For example, the Cleaning Analysis Management System (CAMS) is used to

produce detailed and accurate cleaning costs helping in improving cleaning standards.

Another feature is the food services menu (depicted in Figure 5.19 below) that

provides staff and patients with the daily variety of foods available at various times of

the day.

Figure 5.19: Staff Canteen Menu Page on the City Hospital Intranet.

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5.6 Summary

The aim of this phase of the study was to investigate the nature of the Intranet in use

at the City hospital. A background investigation of the history and development of the

City hospital Intranet was thus carried out. It was also important to investigate the

type, technical specifications and features of the City hospital Intranet. The findings

showed that the City hospital Intranet had evolved out of an older Intranet. The

implementation of the new Intranet led to several technical and non-technical issues

that had to be addressed.

A variety of factors were also identified as facilitating this evolution. This included:

the availability of computers, user involvement, IT support services and staff, a

supportive organisational culture, continual support from senior management,

availability of IT contacts in departments/units and a web-steering committee that

enables better collaboration and communication of needs, wide ranging functionalities

of the Intranet and its links to knowledge bases. Changing from the old to the new

Intranet has also enabled it to evolve in terms of content, structure, functionalities,

ease of usage as well as the widespread adoption across the City hospital. The City

hospital Intranet therefore includes numerous advanced features providing

communication and collaboration, clinical applications, knowledge bases, support

services including financial and HR applications as well as operational and

managerial reports. Usage statistics suggested that the City hospital Intranet is

popularly used.

This chapter has provided a description and background information of the City

hospital Intranet. It has identified the need to investigate how the Intranet is used to

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enable knowledge sharing at the City hospital, including the patterns of usage, user

experiences and any other issues faced by users. It is equally important to gain an in-

depth understanding investigate the role and impact of the City hospital Intranet on

knowledge sharing and the related organisational factors affecting its usage to

determine if it is indeed a success story. The subsequent chapters provide the needed

detailed insight obtained by using a combination of questionnaire and interview-based

methods in the remaining two phases of the research.

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Chapter 6-The Questionnaire-based Study

(Phase Two)


This chapter presents the findings obtained from the data collected in the second

phase of the research investigating the usage of the City hospital Intranet. The

previous chapter provided a general overview of the City hospital and the nature of

the Intranet used.

The findings in this phase are drawn from the online questionnaire responses which

included a combination of open-ended and closed-ended questions using a 5-point

Likert scale rating. Descriptive statistics were then generated and analysed to identify

key issues as well as provide an insight into Intranet usage, content and structure. The

chapter first presents the aims of the study. The online questionnaire method

described in detail. A description of the procedure and data analyses is outlined and

finally the findings of the closed-and open-ended questions of the online questionnaire

are presented and discussed.

6.1 The Aims of the Questionnaire-based Study

The primary aim of this phase of the research was to investigate the opinions of

respondents towards various issues related to the usage of the Intranet for KM. This

was important in identifying the key issues and patterns to be further examined in the

third phase of the study. Using a combination of closed-and open-ended questions

(see appendix A), user responses were gathered. This use of such quantitative

methods allowed the researcher to be an objective investigator through the collection

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of measurable data (Saunders et al., 2003). Questionnaire surveys are importantly

suitable for exploratory research and are easy to use. They provide a structured

approach of gathering responses from a large number of City hospital Intranet users.

This phase of the research addresses the following question and aims noted in the

introductory chapter:


a. Investigating the types and sources of knowledge shared within the

hospital and via the Intranet in particular.

b. Investigating the key mediums for knowledge sharing used in the

hospital.

c. Investigating user experiences and patterns of usage of the Intranet

among users in the hospital.

d. Identifying the key factors influencing the usage of the Intranet,

including user opinions on the factors that facilitate or impede its

usage.

6.2 Method

6.2.1 The Online Questionnaire

An online questionnaire was importantly considered suitable in this hospital research

setting because of the critical nature of the work carried out by respondents. The data

collection instrument therefore had to provide the flexibility of completion regardless

of time and location. The online questionnaire included an online cover letter

describing the purpose of the survey and the strict confidentiality of responses. The

purpose of the online questionnaire was to provide pointers to key issues for

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additional investigation. It consisted of 3 web pages with questions on key areas of the

Intranet, its usage and KM activities. The online questionnaire included a total of 12

questions with 3 open-ended questions (see Appendix A) and involved four main

themes. The first part of the questionnaire consisted of questions asking the

respondents to classify their positions and specializations at the City hospital. The

second part focused on knowledge sources and knowledge sharing mediums that

respondents used, including the Intranet. The third part focused on usage patterns and

experiences with the Intranet, usage frequency and knowledge sharing activities. The

fourth part was composed of three open-ended questions eliciting respondent opinions

on the advantages and impeding barriers faced in the usage of the City hospital

Intranet.

The online questionnaire was estimated, after pilot testing to take approximately 15

minutes to complete which was considered adequate. The questionnaire was

administered to respondents using the online survey program Zoomerang®. The

questions were broad enough to enable the unobtrusive collection of opinions from a

large number of users from the varying functions of the hospital.

An online questionnaire was used because of the significant advantages it has over the

traditional paper survey questionnaire. Some of these include: eliminating mailing

costs, reducing costs of coding respondents data, automated data entry, reducing

human-error, effectively reaching respondents in different geographic locations, wider

distribution in a relatively short amount of time and faster turnaround times (Roztocki,

2001).

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6.2.2 Sample

The sample was drawn from users of the hospital Intranet. Participant recruitment was

solicited via an E-mail broadcast from senior management inviting users to take part.

Intranet users were given advance notice via E-mail about the online survey. An E-

mail with a link to the questionnaire was then sent out to all Intranet users.

Respondents were duly informed at the beginning of the questionnaire of the purpose

of the survey and the confidentiality of their responses. The respondents were also

informed that only aggregated results will be reported or published for academic

research purposes. The names and contact details of the researcher and supervisor

were also included for contact with regards to comments or concerns about the

survey.

A total of 356 respondents completed the online questionnaire in full while 60

questionnaires were partially completed. Each individual response was confidential

and respondents were only allowed to take the survey once to avoid multiple entries.

Respondents were also prompted by the online questionnaire if they missed an option

or a question. This ensured completion and reduced errors. Due to the time constraints

and the previous history of City hospital survey responses at the hospital, the response

rate was rated a high success.

6.2.3 Procedure and Data Analyses

After obtaining initial approval and agreement by the City hospital for undertaking the

survey as well as the Human Research Ethics approval from UTS, the online

questionnaire was put through several drafts. It was initially pilot-tested with City

hospital Intranet users from various departments and functions to test wording and

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layout. Zikmund (2000) describes a pilot survey as any small-scale exploratory

research technique that uses sampling and which is conducted to serve as a guide for

the larger study. Ticehurst & Veal (1999) explain that a pilot survey increases the

researcher’s familiarity with respondents and test arrangements. The authors view the

pilot survey as important for testing all aspects of the survey, not just for the wording

of the questions. The feedback and comments from the pilot study regarding the

structure and content allowed for minor changes and clarifications to be made as

required (e.g. the refinement of some questions to enable better focus on an issue).

The responses obtained from the questionnaires were initially gathered using the

online survey program Zoomerang®. They were then transferred to and analysed

using the SPSS® statistical software package. Descriptive statistics were subsequently

generated to identify key issues and provide a descriptive picture of Intranet usage at

the hospital. The open-ended questions were able to depict user perceptions on the

advantages and disadvantages of the Intranet, as well as identifying the encompassing

organisational conditions enabling or impeding usage. Standard statistical measures

were employed, including the means and standard deviations of rating-scale responses

as measures of central tendency and dispersion, respectively. The following section

outlines the breakdown of the responses to each question and brief discussions on the

findings.

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6.3 Findings

Table 6.1: Classification of Respondent Positions in the City Hospital

Number of Responses

Percentage (%)

Senior management

24

7

Middle management 57 16

Supervisory role 37 10

Team member/worker bee 209 59

If Other, Please Specify 29 8

Total 356 100

The findings on job classifications in Table 6.1 above showed a broad range of

respondents with a majority being team members/worker bees (59%), followed by

those in middle management and supervisory roles with a combined percentage

(26%). Users with senior managerial positions amounted to 7% of the respondents and

29 respondents (8%) classified themselves in ‘other’ category. Those in this category

included a respondent that held both a senior and middle management position,

medical students, hospital consultants, volunteers and specialists.

Table 6.2: Classification of Respondents Specializations in the City Hospital

Number of Responses

Percentage (%)

Medical

60

17

Nursing 91 26

Clinical 13 4

Corporate/Support 64 18

Allied health 71 20

If Other, Please Specify 57 16

Total 356 100

Looking at the results of the classification of respondents in Table 6.2 above, a

majority of the respondents (25%) classified their area of specialisation as ‘nursing’.

‘Allied health’ workers amounted to (20%) of respondents and 64 respondents (18%)

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were ‘corporate/support’ workers. Sixty respondents (17%) were from the ‘medical’

profession while 13 respondents (4%) were ‘clinical’ workers. The 57 respondents in

the ‘other’ category (16%) were made up of ‘clinical research’ and ‘IT’ workers. The

results from Table 6.1 and Table 6.2 highlighted a varied group of respondents

(Intranet users) from different specializations in the City hospital. Large hospitals are

both highly specialized and reflect a complex division of labour (Atkinson, 1995;

Blume, 1991). It was important to get wide-ranging views on the issues investigated

across the various strategic groups and specialisations of the City hospital. A broad

mix of key ‘influencing’ and ‘influenced’ respondents from a myriad of different

contexts at the City hospital help through the provision of multiple sources of

opinions, ensuring a comprehensive perspective on the usage of the Intranet.

Table 6.3: Ratings of How Critical Sources of Knowledge are in the Carrying

Out of Respondents’ Daily Work in the City Hospital

On a scale from 'strongly disagree' to 'strongly agree' (where 1 is ‘strongly disagree’ and 5 is

‘strongly agree’)

1 Strongly Disagree 2 3 4

5 Strongly

Agree

Mean

Mode

SD Other employees in my unit/department

1.1% 4

1.7% 6

23.3%83

25.8%92

48.1% 171

4.18 5 0.93

Employees in other units/departments

17.1% 61

8.4%30

41.3%147

15.5%55

17.7% 63

3.08 3 1.28 External partners

15.7% 56

55.1%196

9.8%35

5.6%20

13.8% 49

2.47 2 1.23 Communities of practice/interest

19.7% 70

6.7%24

22.2%79

30.1%107

21.3% 76

3.27 4 1.39 Intranet

0.6% 2

16.0%57

24.7%88

33.4%119

25.3% 90

3.67 4 1.04

Books (e.g. Journals)

17.9% 64

21.1%75

38.2%136

6.5%23

16.3% 58

2.82 3 1.27

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As can be seen from Table 6.3 above, a majority of respondents rated ‘Other

employees in my unit/department’ as the most critical source of knowledge (mean of

4.18). Respondents indicated that the Intranet (mean of 3.67) was the most important

knowledge source followed by communities of practice/interest.

Table 6.4: Level of Use of Different Mediums for Knowledge Sharing with People within the City hospital

On a scale from 'Not at all' to 'Very often' (where 1 is ‘Not at all’ and 5 is ‘Very Often’)

As shown in Table 6.4, the most popular medium for knowledge sharing was the

telephone (mean of 4.18). Email communication which is a feature of the Intranet at

the City hospital was the second most popularly rated medium for sharing knowledge.

Excluding video conferencing which was rated quite low (mean of 2.17), respondents

used departmental network drives, informal and formal meetings a similar frequency

(mean range between 3.66 and 3.78).

1 Not at

all 2 3 4

5 Very Often

Mean

Mode

SD

Telephone

2.5% 9

9.0% 32

17.1% 61

18.3% 65

53.1%189

4.18 5

1.09 E-mail

4.8% 17

15.2% 54

15.7% 56

24.4% 87

39.9% 142

3.79 5

1.25

Shared departmental network drives

5.6% 20

2.2% 8

37.9%135

16.9%60

37.4%133

3.78 3

1.14 Video conferencing

41.0% 146

23.6%84

19.4%69

9.6% 34

6.4% 23

2.17 1

1.24

Formal meetings

4.5% 16

6.5% 23

39.3% 140

20.5% 73

29.2% 104

3.63 3 1.02

Informal meetings

2.0% 7

8.7% 31

36.0%128

27.8%99

25.5%91

3.66 3 1.10

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Table 6.5: Frequency of Intranet Access and Usage for Daily Work by Respondents’ in the City Hospital

Number of Responses Percentage (%)

Once a day

45

13

Several times a day 261 73

Every 2-3 days 25 7

Weekly 10 3

Fortnightly 15 4

Total 356 100

Table 6.5 reports the results of the number of times respondents access the Intranet

daily for work. As can be seen from Table 6.5, 261 respondents (73%) accessed the

Intranet ‘several times a day’. The next significant number of respondents that

accessed the Intranet from once a day to every 2-3 days (a combined total of 20%).

Table 6.6: Average Time Spent Weekly on the City hospital Intranet by Respondents

Number of Responses

Percentage (%)

Less than 2 hours

169

47

2-5 hours 133 37

6-10 hours 34 10

11-15 hours 8 2

16-20 hours 5 1

More than 20 hours 7 2

Total 356 100

The average time spent by respondents weekly on the City hospital Intranet as shown

in Table 6.6 presents a slightly different picture. While 73% of respondents indicated

that they accessed the Intranet several times a day in Table 6.5, 47% spent less than 2

hours on the Intranet per week. A cumulative percentage (84%) of respondents spent

less than 5 hours on the Intranet per week.

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Table 6.7: Frequency of Respondents Access and Usage of the City Hospital

Intranet Features

On a scale from 'Not at all' to 'Very often' (where 1 is ‘Not at all’ and 5 is ‘Very Often’)

As can be seen in Table 6.7, respondents used the different features and resources of

the City hospital Intranet quite frequently. Communication features such as the online

phonebook and Intranet paging system was popularly used (mean 4.33). The Intranet

was the primary means of receiving organisation-wide news and information and this

was reflected in the mean of 3.63. Additionally, the online lunch menu was a popular

feature with users with a mean of 3.45. This was because the canteen was where

employees would normally congregate and have meals. The City hospital Intranet was

similarly used frequently for accessing knowledge documents and databases, clinical

software (e.g. CIAP), on-the-job training programs and for obtaining information

1 Not

at all 2 3 4

5 Very Often

Mean Mode

SD Documents and databases (e.g. policies and procedures)

6% 22

21% 76

22% 79

26% 92

24% 87 3.41 4 1.24

On-the-job training (e.g. videos)

1% 3

2% 8

49% 176

17% 59

31% 110 3.74 3 0.95

Information about services from departments

6% 21

27% 96

33% 117

21% 73

14% 49 3.09 3 1.12

Phone numbers and paging system

4% 13

4% 15

11% 39

18% 65

63% 224 4.33 5 1.06

Lunch menu 15% 52

16% 58

17% 59

15% 53

38% 134 3.45 5 1.49

Organisation-wide news and communication (e.g. regular updates)

6% 21

17% 61

17% 60

29% 102

31% 112 3.63 5 1.25

NSW Health Intranet and CIAP (Clinical Information Access Program) website

14% 49

20% 71

20% 70

25% 90

21% 76 3.21 4 1.35

Information on vacant positions

33% 118

35% 123

18% 65

10% 35

4% 15 2.17 2 1.12

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about other departments. The HR page that advertised vacant positions was not found

to be popularly visited and this was reflected with a mean of 2.17.

Table 6.8: Respondents’ Rating of Current Experience with the City Hospital

Intranet



As can be seen from Table 6.8 above, respondents seemed to rate their experience of

using the City hospital Intranet above the scale mid-point of 3 with most of the

indicators. The highest mean of 3.42 was for the easy navigation of the City hospital

Intranet. The lowest mean of 2.43 was for the availability of profiles of employee

expertise.


5 Strongly

Agree

Mean

Mode

SD Easy navigation

2% 10

12% 41

36% 128

40% 142

10% 35 3.42 4 0.92

Easy finding of documents (e.g. forms and policies/procedures)

7% 24

26% 92

36% 129

26% 93

5% 18 2.97 3 0.99

Ability to identify the person/source of the knowledge

4% 16

23% 80

46% 164

22% 78

5% 18 3.01 3 0.91

Availability of profiles of employees expertise

16% 55

37% 132

38% 136

7% 26

2% 7 2.43 3 0.91

Personal uploading and editing of knowledge relevant to my work

11% 40

26% 92

40% 141

21% 75

2% 8 2.77 3 0.98

On-the-job training (e.g. E-learning tools)

15% 54

33% 119

37% 132

12% 44

2% 7 2.53 3 0.96

Sharing of documents relevant to my work

9% 33

25% 89

38% 134

23% 81

5% 19 2.90 3 1.03

Knowledge accessed on the Intranet is up-to-date

6% 22

22% 79

40% 144

25% 88

7% 23 3.03 3 0.92

Provision of feedback/comments

11% 40

33% 119

41% 146

12% 42

3% 9 2.61 3 0.99

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Table 6.9: Respondents’ Rating of Factors for Improved Usage of the City

Hospital Intranet `



The results of the rating of factors for improved usage in Table 6.9 above showed that

most respondents would make better use of the City hospital Intranet if the search

functionality was improved. A cumulative percentage of almost 70% of respondents

agreed and strongly agreed (mode of 4 and mean of 3.65). This was followed by

respondents indicating the need to upload relevant information directly to their

websites. The results however showed some inconsistencies in the responses of

respondents. The respondents seem to reject the allocation of more time for training

on the usage of the City hospital Intranet and for better training on how to use the City

hospital Intranet. The rating of most respondents showed a comparably lower mean of

2.84 and 2.95 respectively. This again could be linked to time constraints.

1 Strongly Disagree

2

3

4

5 Strongly

Agree

Mean

Mode

SD

It had improved search ability

3.9% 14

10.7%38

27.0%96

33.4%119

25.0% 89 3.65 4

1.09 I had the ability to upload relevant information directly

3.9% 14

12.9%46

30.1%107

34.6%123

18.5% 66 3.51 4

1.06 I had better training on how to use the Intranet

14.0% 50

24.4%87

27.5%98

20.5%73

13.6% 48 2.95 3 1.25

I was given time to learn how to use the Intranet

17.4% 62

26.7%95

23.1%82

20.2%72

12.6% 45 2.84 2 1.29

Availability of staff profiles and skills

6.8% 24

26.1%93

31.7%113

13.2%47

22.2% 79 3.18 3 1.23

The Intranet had quick links to documents used frequently

2.0% 7

8.4%30

43.3%154

22.4%80

23.9% 85 3.58 3 1.01

Best practice regarding usage of the Intranet was made available

4.2% 15

13.2%47

30.9%110

37.1%132

14.6% 52 3.45 4 1.03

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Respondents seemed to prefer getting best practice knowledge on the City hospital

Intranet usage and this is reflected in the rated mean of 3.45.

Table 6.10: What Respondents Find Useful and Important about the City

Hospital Intranet

Number of Responses

Percentage (%)

Ease of Access to Information and Tools

81

36 Finding and Contacting Employees

47 21 Knowledge Sharing

38 17

Collaboration

18 8

Online Training and Education

16 7

Speed and Ease of Navigation

14 6

Cafeteria Menu

11 5

Total 225 100

In order to give respondents the opportunity to express other opinions about the City

hospital Intranet in general, three open-ended questions were asked in the survey. The

responses to the open-ended questions by respondents proved to be very rich and

valuable.

Table 6.10 above shows that there were a total of 225 responses to the question

regarding what respondents found useful and important about the City hospital

Intranet. Respondents were asked to provide examples and their responses were

categorised. Common comments on the usefulness and importance of the

Intranet included the Intranet being viewed as providing easy access to information

and tools (e.g. access to and submission of work relevant forms online) and access to

specialized software programs/knowledge bases (e.g. CIAP). Other popular comments

173

by respondents include the Intranet being viewed as a medium for easy online

connection to other employees (e.g. using the paging system and contact information).

The centralised sharing of aggregated knowledge that is easily accessed by users (e.g.

‘what’s new’, work/task-related information, links to frequently used topics and

documents). Respondents also stated that it provided access to synthesised &

processed knowledge documents with examples of best practice, policies &

procedures, drug doses and protocols, medical reports, clinical documents and patients

list being offered.

Table 6.11: Factors that Impede the Usage of the City Hospital Intranet

Number of Responses

Percentage (%)

Search Functionality

82

40

Lack of Time

39 19

Layout Structure

28 14

Lack of Training

27 13

Lack of Awareness of Benefits

18 9

Information Overload

10 5

Total 204 100

There were a total of 204 responses to this question as shown in Table 6.11.

Responses were categorised and an analysis of these responses revealed that the

common comments on factors that act as barriers to the usage of the Intranet included:

The search functionality/problems with searching the City hospital Intranet was the

most common complaint. The increased size of the Intranet had created the need for a

faster and more sophisticated search engine which was not available at the time of this

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research. The lack of consistency regarding information presented on departmental or

project websites also made searching more tedious. Another common factor

mentioned by respondents that impeded the usage of the City hospital Intranet was the

lack of time available to learn and make appropriate use of it. This was also referred

to as ‘time pressure’. A lack of training and knowledge of usage was also noted as an

impeding factor.

Moreover respondents stated that the design and navigation of the City hospital

Intranet impeded its usage. Two major factors regarding the content, the information

being out of date and too much information being made available were also

highlighted as a factors impeding usage of the City hospital Intranet.

Table 6.12: Other Comments by Respondents about their Experiences with the

City Hospital Intranet

Positive Comments

“Generally I find the Intranet very useful. Having remote access dial

in to it is an advantage”.

“It is the best I have used so far (and I have worked in a lot of

hospitals)”.

“I like the paging system and use it constantly”.

“Cafeteria menu is great”.

“Has made life a little easier”.

“The intranet paging is excellent”.

“Actually quite a good set up”.

“I think the Intranet is well organised & the IT staff are helpful”.

“Much better than my previous place of employment, and I have a

computer on my desk, too”.

“It is a wonderful and up to date information access point”.

Negative Comments

“It is no substitute for going and speaking to another staff member

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Negative Comments (cont’d)

and asking for explanation”.

“Overloaded, too slow, limited capacity for new features such as

video streaming, discussion groups, communities, etc”.

“Looking for forms can be confusing. Some forms are in Word but

you can also be out of date ones”.

“When searching it often brings up a lot of irrelevant stuff and

rarely what you are looking for. Some forms I found hard to find –

had to ring appropriate dept to find out where the form was”.

“Better than it has been but frustrating search engine”.

“I need more training but find it difficult to take the time during the

day. After hours would be preferable, as it would not be cutting into

clinical work. The courses offered here are excellent, I think, but it's

hard to be sure of getting to courses on time when one is doing

clinical work. I guess I give priority to clinical work, even though I

know doing a course would make me more efficient”.

“I probably should take some time to familiarise myself with its

capabilities but as I only work part time it never seems to get to the

top of my to-do list”.

“Just need a little more time to learn how to navigate it effectively”.

“Require further education”.

The analysis of the responses to this question showed that no distinct themes emerged

different to those already revealed. Responses were therefore broadly grouped into

positive and negative comments on the City hospital Intranet as shown in Table 6.12

above. There were 107 responses to this question. Popular responses included the

Intranet being generally good or excellent. The Intranet showing a marked

improvement in the last 12 months and being well organised, the IT staff being

helpful, a good experience, easy to use for most things needed, generally helpful and

needs to be a commitment of personnel/money/time from the hospital. Negative

comments were generally centred on the search functionality not being adequate and

the need for more training.

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6.4 Summary of Findings

In summary, the findings reflected the aims of this phase of the research by serving in

the understanding of the knowledge sharing activities that the Intranet was used for.

They contributed to the understanding of the various knowledge sharing mediums and

sources of knowledge used in addition to the Intranet at the City hospital. The findings

also revealed the patterns of Intranet usage, popular Intranet features used and what

respondents found important and beneficial about of the City hospital Intranet. Key

issues from the users’ experiences that impeded the usage of the Intranet were also

highlighted which suggested the need for further investigation.

These key issues include the popular use of various non-electronic knowledge sharing

mediums at the City hospital such as face-to-face meetings (formal and informal

respectively). The findings showed that people in similar departments were

considered more critical sources of knowledge than people in other departments. The

results of this phase of the research also exposed the barriers that respondents felt

impeded the usage of the Intranet such as poor search functionality, lack of time,

layout structure and training. These issues are investigated further in the next phase of

the research discussed in the following chapter.

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Chapter 7-The Interview-based Study

(Phase Three)


The findings of the first and second phases of the research presented in the previous

two chapters provided an overview of Intranet usage, content and structure. It exposed

certain key issues that influenced the usage of the City hospital requiring further

investigation. This phase of the study used semi-structured interviews to capture the

users’ perceptions and opinions about the key findings revealed in previous phases. In

addition, it investigated the usage of the City hospital Intranet for knowledge sharing.

7.1 The Aims of the Interview-based Study

This phase of the research aimed to gain an in-depth understanding of the issues and

patterns identified from the first and second phases of the study. A qualitative

approach was adopted to gain critical insight into what participants knew and felt

(Patton, 2002). This phase of the study adopted an interpretative approach used for

investigating the usage of IT tools (Klein & Myers, 1999; Walsham, 1993). While

interviews were the primary source of data, it also relied on various other sources such

as informal discussions, usage demonstrations and document analyses.

This phase addresses the following questions


This question had the following aims:

178

a. Investigating user opinions of knowledge and KM, particularly



c. Investigating the impact of the Intranet on the knowledge sharing

processes represented by Nonaka & Takeuchi’s (1995) knowledge

conversion model.


within the hospital? Of particular interest is the need:

a. To investigate the key difficulties impeding the usage of the Intranet at

the hospital.

b. To investigate the influence of culture and structure on the usage of the

Intranet for knowledge sharing at the hospital.

7.2 Method

In order to provide deep and critical insight into the issues being investigated, face-to-

face semi-structured interviews were carried out with Intranet users from different

specializations and at different hierarchical levels within the City hospital. These

included the Deputy Chief Executive Officer (CEO), several directors, senior

managers who not only use but oversee the administration of the City hospital Intranet

and general users. As Neuman (2003) points out, contrasting types of informants, each

very familiar with the topic being investigated and the local context provide a useful

range of perspectives when conducting field research.

179

Yin (1994) describes the conduct of several interviews in a case study as an

appropriate method for gathering information on contemporary behaviour within its

real-life context and as being capable of producing findings that are generalisable to

theoretical propositions. As Sekaran (2003) also points out, the semi-structured

interview technique is a recognised approach when the overall area of information

needed is known. These in-depth interviews allow individual subjective experiences

to be captured by allowing the interviewees to give their opinions and feedback on the

identified issues being investigated. The interviews also encourage interactive

communication by allowing the interviewees to express their opinions clearly while

also clarifying any ambiguous opinions or issues. Ammenwerth et al. (2003) suggest

that directly addressing participants in a hospital setting increases support for and

participation in the research study.

7.2.1 Sample

The City hospital like most large hospitals has various divisions, departments, units

and highly skilled employees. This research cannot do justice to this variation in a

comprehensive manner. Rather, an appreciation is obtained through the expression of

various views from the major and strategic units/departments in the City hospital by

interviewing the key actors. The interviewee sample was selected based on the

reputational approach (Scott, 2000). Initial contacts at the hospital that had good

knowledge of the Intranet users gave suggestions for participants from the major

occupational/professional groupings of the hospital to be included in the study. These

suggestions were studied by the researcher and a total of 50 participants were selected

for in-depth interviews (See Table 7.1 below for interviewee classifications). This

selection of participants was considered adequate as it enabled the representation of

180

the major occupational/professional groupings and their views. This was important to

avoid bias. It also allowed recognition of the different hospital functions who would

in many cases face unique issues, needs and consequently have different views of the

Intranet.

Sample Classification

Number Executive & Middle management

7

Team leaders

10

Administrative staff

5

General users

23

Clinicians

5

Total

50

Table 7.1: Classification and Number of Interviewees

Executive and Middle management interviewees included the Deputy CEO, City

hospital directors and departmental heads (e.g. Head of the department of Nursing,

HR manager, IT manager, and Training and Education manager). Interviewees also

included team leaders (e.g. Head nurses and medical doctors), administrative staff

(e.g. secretaries and librarians) clinicians (e.g. laboratory technicians and analysts)

and general users (e.g. medical doctors, duty nurses, hospital researchers and Allied

health workers).

Within these categories listed in Table 7.1 above, there was still some variation within

the job classifications of the participants. Job classifications at the City hospital were

not always strictly distinct. For example, Heads of department were mainly specialists

(e.g. doctors) held administrative roles while performing their duties as doctors.

181

7.2.2 Procedure and Data Analyses

Prior to the commencement of this phase of the study, clearance and approval from

the UTS Human Research Ethics Committee was obtained. Clearance and approval by

the City hospital for the interviews to be undertaken was also granted. Miles &

Huberman (1994) explain that data collection is inescapably a selective process. An

iterative process was thus consistently employed throughout this research to enable

the analysis of the various opinions gathered.

To ensure the highest possible response rate, Stanton & Rogelberg (2001) list methods

of boosting response rates, including advance notices, incentives, introductions and

reminder notices. The selected interviewees were approached by E-mail which

included an attached information statement (see Appendix B) and given advance

notices before each interview. All interviewees received and signed a letter of consent

(see Appendix C) outlining the purposes of the research and the confidentiality of their

responses. This process was necessary for strengthening research validity, integrity

and as part of research ethics requirements. Interviewees were also thanked them for

their participation prior to the commencement of every interview. A thank you card/E-

mail was also sent as a token of appreciation after the completion of each interview.

Informed consent was obtained for the tape recording prior to the commencement of

each interview. It was also obtained for note taking during the interview and

transcribing of the interviews verbatim for content analysis, as suggested by Gilbert

(1995). Participants were made aware that they could stop the tape recordings at any

stage during the interview. The duration of the interviews was approximately from

one to one and a half hours. An interview guideline/checklist (see Appendix D) was

182

used to outline the questions/issues to be covered and ensured structure, consistency

and increased validity of the research. Data gathered from the two phases of the

research, including document reviews and analysis (e.g. strategic City hospital

documents, Intranet usage statistics and log files) were used to inform the interview

questions. The interview questions probed specific issues about the Intranet (e.g.

usage, relevance, issues faced, suggestions for improvement and influencing

organisational conditions) as well KM related issues (e.g. types of knowledge shared,

sources of knowledge, knowledge flow within and across departments, KM practices

and difficulties in the usage of the Intranet as a knowledge sharing tool). During the

interviews respondents were encouraged to talk freely about their Intranet experiences

and were thus able to contribute to the pace and direction of the interviews.

The taped interviews were transcribed professionally at the end of each interview and

key issues were identified and used to modify the interview questions for better

probing. The transcribed interviews were analysed using content analysis (Miles &

Huberman, 1994) to identify and categorise keywords and themes. This involved the

use of certain criteria. Each issue/factor had to be mentioned and supported by

multiple respondents. Respondents also provided examples of how a particular

issue/factor has influenced usage of the hospital Intranet for knowledge sharing.

According to Ahmed et al. (2002), qualitative data analysis involves pattern

arrangements of the data to form information that is integrated into thinking and

feeling to provide knowledge. This interpretative approach allowed the researcher, in

addition to being involved in the collection and analyses of the data, to better

understand the issues under investigation. Using the aims of this phase of the study as

183

guidelines, thematic coding and data reduction strategies were adopted to sharpen,

sort, focus and organise the findings into a coherent and logical whole.

The findings were consolidated into different thematic groupings from which

conclusions could then be drawn (Miles & Huberman, 1994; Boyatzis, 1998).

Separate tables were then created to distinguish between the different issues

investigated (Strauss & Corbin, 1990; Andersson et al., 2003). These were then

organized in conceptual clusters in order to build a logical chain of evidence. An

inductive approach was thus applied in categorising these themes based on the data

collected. The categorisation of the data was able to provide a contextual analysis

with an interpretative orientation. The use of tapes allowed the replaying of segments

of the transcripts that reported specific issues or themes being identified. This

approach was relevant for the research as it focused on the ‘how’ and ‘what’ of

people’s experiences, based on socially constructed meanings and/or interactions.

This systematic analysis leads to the development of a context-based description and

explanation of the phenomenon (Orlikowski, 1993). There was a final modification of

the categories developed after consideration of comments made by participants so as

to avoid any bias or misinterpretations (Andersson et al., 2003; Glaser, 1978). The

aggregated findings were also shared and discussed with several academics,

healthcare experts and IT professionals, thus increasing validity.

The following sections present the key themes and comments from interviewees. It

presents a detailed narrative with emphasised themes revealed through the personal

opinions, feelings and Intranet usage experiences of the interviewees. This enabled

critical insight into and an understanding of the dynamics and relevance of each

investigated issue related to the usage and impact of the City hospital Intranet.

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7.3 Findings

7.3.1 The Definition of Knowledge and KM at the City Hospital

In investigating the role and impact of the Intranet on knowledge sharing at the City

hospital, it was important to ascertain user perception of knowledge and KM. The

interviews revealed different understandings and opinions by participants of what they

believed constituted knowledge and KM at the City hospital. How knowledge was

defined depended on the role of the person in the hospital, or as one interviewee

stated: “depended on what hat I was wearing” and would thus vary based on job roles

in the City hospital. Several definitions and views of knowledge were proffered,

including: “knowledge of how the hospital works”, “who’s who at the hospital” and

“policies and procedures”. Other interviewees described knowledge as: “skills”,

“personal experience”, “theoretical knowledge that we picked up in university”,

“clinical experience”, “professional experience”, “training that informs the way work

is performed”, “information that is useful, meaningful and has a purpose”,

“knowledge about how to access other points of knowledge” and “awareness of the

latest information as its becoming available”. Some linked the City hospital Intranet

with knowledge. As one interviewee expressed, “it’s all about using the Intranet for

access to the critical information I need to do my job”.

In terms of defining KM, interviewees also expressed multiple views or

understandings with varying comments. One interviewee described it as: “how

knowledge is developed, shared and communicated”. Some were not aware of the

concept, while a majority felt that KM was existent but under different labels within

the hospital. An interviewee pointed out: “We do have such a framework but it is

more naturally present and doesn’t exist under that name for us”.

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7.3.2 Knowledge Sharing at the City Hospital

7.3.2.1 The Types of Knowledge Shared at the City Hospital

Interviewees were asked to classify the types of knowledge shared in the City hospital

and provide examples. The findings showed that a combination of different types of

knowledge was shared depending on the job roles of the employee or the

organisational needs at the City hospital.

Clinical workers and other healthcare specialists at the City hospital were found to

rely on their background knowledge. This included their skills, training and

experience. As a medical doctor and Department Head also pointed out, medicine was

in many ways still an: “oral tradition”. One interviewee further explained: “although

we are a very IT based hospital there is still a lot of implicit knowledge that isn’t

captured. The explicit information you find on the Intranet is just the tip of the iceberg

even though we use it mostly for communication”.

Usage of the Intranet for knowledge sharing depended on user job roles or needs

which could be based on the different specializations of the users. Many of those

interviewed used the City hospital Intranet to: “share departmental information,

policies and procedures”. Others found it very useful for accessing: “forms from other

departments”. Usage of the Intranet was also for: “internal hospital service delivery”,

“two-way communication”, “gaining access to knowledge bases”, “accessing

electronic medical records”, “sharing clinical applications and software” and “Allied-

health E-learning tools”. Popular usage also centred on the online paging system.

“The paging system is fantastic” an interviewee expressed. Departmental/unit

managers were found to also encourage knowledge sharing using the City hospital

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Intranet by directing staff enquiries to it. As an interviewee remarked: “we usually

direct people to links on the Intranet”.

Although a majority of interviewees stated that they shared more ‘tacit’ knowledge

using for example: “mentoring programs such as ward grand rounds”, they also

stressed their critical need and usage of explicit knowledge. Explicit knowledge on the

Intranet could be found in the form of “policies and procedures”, “forms”, “manuals”,

“evidence-based research papers”, “staff and departmental contact information”,

“knowledge bases” (e.g. CIAP), “patient lists” and “online minutes of meetings”.

The Intranet allows you, as one interviewee put it: “to get the information when you

need it, not before. So it’s like a just-in-time concept”. In terms of tacit knowledge,

most interviewees felt that it is something that is: “constantly being regenerated and

reproduced”. Some popular mediums included “chats in the coffee lounge”, “training

sessions” and “apprenticeships”.

In exploring the impact of the Intranet on knowledge sharing at the City hospital, it

was important to examine knowledge sharing in general at the hospital. Overall, it was

apparent that knowledge sharing was very important at the City hospital and to its

employees, because as one interviewee explains: “this is very much a teaching

hospital and people are very aware of that”.

Interviewees were asked to use a metaphor to describe the sharing of knowledge

across the City hospital. Some of the following were used (see Figure 7.1 below):

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Figure 7.1: Metaphors Used for Knowledge Sharing at the City Hospital

The responses as shown in Figure 7.1 above showed a variation in how interviewees

viewed knowledge sharing at the hospital. Upon probing, interviewees explained that

this was due to knowledge sharing varying from within and across departments. This

is discussed in more detail in the following sections.

7.3.2.2 Knowledge Sharing within Departments

Almost all interviewees stated that knowledge sharing within their departments was

free flowing. This was facilitated by a shared understanding as one interviewee stated,

because: “we are used to the same terminology and jargon”. Knowledge sharing

within departments according to interviewees thus occurred especially at the: “oral

level” and because as the people involved “are contained in the one single area”.

Employees were able to develop “informal networks” such as CoP’s/CoI’s created as

a result of work interaction. Reasons for the lack of proactive knowledge sharing

revolved around a: “lack of time” or sharing being: “personality dependent”,

“differences in needs” as well as the: “significant level of staff turnover”. One

interviewee pointed out: “I think there’s an open sharing of knowledge but we’re just

busy and we had a lot of staff changes”.

Patchy Siloed

Free flowing

Disjointed

Open Tribal

Haphazard

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There were various mediums through which knowledge was shared within

departments and some included: “day-to-day formal and informal meetings”, “task

handovers” and “chats in the corridor”. Features of the City hospital Intranet were

also used, including: “E-mails”, “online discussion forums”, “shared data drives” and

“online meeting minutes and outcomes”.

The City hospital Intranet was also used in the: “storage of departmental knowledge”,

“sharing of departmental meeting minutes”, “best practices” and “decisions and

announcements”. The type of knowledge shared was usually department specific. An

interviewee in discussing the nursing department as an example explained that many:

“medical records”, “discharge summaries” and “paediatric palliative care notes”

were shared. Interviewees viewed the type of knowledge shared within their

departments to be a more tacit type of knowledge: “... there is a lot of learning by

observation”. Another explained: “the knowledge we share within the department is

more tacit, you are there and people around you can ask someone rather than looking

for a manual”.

Interviewees also pointed out that determining what knowledge was shared on the

City hospital Intranet and how it was decided was a collective task, as reflected in the

following comments:

“If you look at every department, they have different ideas of what is relevant

and so they have different content. In our department we are very much self-

determining around here. The team has a big say in what is decided”.

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“We all have our say in what is relevant so we have a broad scope of

opinions”.

“We have, I guess in terms of the research office, we have a group that gets

together so we coordinate among ourselves what we deem is worthwhile going

up on the Intranet. I think its something that everybody’s got at the back of

their minds, that as soon as we have a new policy, procedure it automatically

goes up there”.

7.3.2.3 Knowledge Sharing between Departments

While there were mixed responses, most interviewees mentioned that knowledge

sharing across departments was not as frequent or free flowing as they were within

departments. One interviewee mentioned: “there are tribes within the hospital and

while they communicate well between their own members, there is a lot of difficulty in

inter-tribal communication”. However, on the contrary, some interviewees described

knowledge sharing across departments as very free flowing and felt this was due to

the close working relationships and the: “many multi-disciplinary meetings we

organize”.

Many interviewees also mentioned that usage and sharing of knowledge via the

Intranet depended again on the: “personalities of the users” because for example:

“with E-mail contact we build up a level of trust and confidence in each others work

so we bounce ideas of each other. It has facilitated a lot of projects” and “this varied

from department to department” and depended on the: “different knowledge needs of

each department” or each stakeholder group (e.g. medical doctors, nurses and

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administrators). An interviewee mentioned that informal networks (e.g. CoP/CoI)

“provided the opportunity for inter-departmental awareness and learnings” but

knowledge sharing was however considered be slow because as another explained:

“when we deal with people outside the department we need to cut the jargon and that

slows down the time it takes to communicate”.

Consistent user involvement with the City hospital Intranet to share knowledge across

departments was: “dependent on your role in the organisation since some things are

only available on the Intranet”. One interviewee explained: “it depends on who

people are; how interested they are in communicating; I think it is well in some

departments and not in others. It is very variable”. Another pointed out that

employee’s professional backgrounds could affect how effectively the Intranet was

used, explaining: “I think it’s probably more associated with the type of work that you

do. So I think that a clinician or as a researcher it’s just inherent to their work that

they’d be talking a lot to people”.

The findings also highlighted tensions that occurred between departments that

affected knowledge sharing. This included the traditional competition for resources

and relevance in the organisation: “sometimes there is a feeling of one upmanship if

‘we’ [emphasised] possess some knowledge that other’s don’t. So it is sometimes

shared in a spirit of ... we know more than you rather than... this is important

information for others to know”.

Another example was the commonly held view by interviewees that the: “nursing

department was too powerful” at the City hospital, with one interviewee suggesting

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that it: “could sometimes affect its relationship with other departments”. However,

interviewees also felt that being a teaching hospital and with a hospital culture

favoured knowledge sharing: “tribes come together when they have to” and there was

no “attempt at purposely hoarding knowledge”. Interviewees also mentioned that it

helped to reduce the barriers between units as they are better able to appreciate the

role of each individual unit and how they contribute to the overall hospital goals and

objectives. As one interviewee put it: “the Intranet is playing a bigger role for us in

terms of access to knowledge and information about the role and importance of other

hospital units”.

The knowledge shared was a mixture of tacit and explicit knowledge, as an

interviewee disclosed: “we share a lot of procedural documents such as hospital

policies and procedures”. The mediums for inter-departmental knowledge sharing

included: phone calls, chats in the coffee lounge, staff canteen and the ubiquitous and

popular chats in the corridor or “information walkways”. Respondents explained that

chats in the corridor were good ways to quickly “discuss professional matters”, for

the “sharing of opinions and experiences”, “catching up with other colleagues” and

for “generally finding out what’s going on” at the City hospital. Other mediums

included: “cross-functional meetings”, “multi-disciplinary committee meetings” and

“staff training programs”.

Numerous features of the City hospital Intranet were used for knowledge sharing and

they included: “E-mail”, “online discussion forums”, “knowledge bases”, “online

meeting minutes and outcome reports”, “online best practice reports jointly developed

by several departments” and “access to other departmental Intranet websites”.

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Additionally, other City hospital Intranet features used included multimedia resources

such as: “videos of hospital ground rounds”, “online newsletters”, “electronic medical

records” and the “online all-user communiqués”.

7.3.3 Sources of Knowledge at the City Hospital

Interviewees were asked to identify what they considered as critical sources of

knowledge within the hospital. The findings indicate that various sources of

knowledge were used at the City hospital. Varying degrees of importance were also

ascribed to the knowledge sources by the interviewees. The most critically identified

knowledge sources could be categorised as non-electronic (people) and electronic

(Intranet). They are presented below.

7.3.4.1 Non-Electronic: People

Most of the interviewees mentioned: “other people” as the most critical sources of

knowledge in the hospital. People as sources of knowledge were described as people

within the interviewees departments and people in other departments. Most

interviewees mentioned their preference for face-to-face and phone contacts with

others: “face-to-face gives you a lot more detail and allows for clearer understanding

of what is being shared”. It was common to observe medical staff participating in

‘corridor chats’ discussing issues regarding patients. For example, a medical doctor

and a ‘serious’ looking resident clown were witnessed by this researcher discussing a

child’s ailment. In response to a question about this occurrence, the doctor involved

explained: “the clown in the wards discusses what he notices from the kids with me as

I do my rounds and this adds to my pool of knowledge about a particular patient”.

The clown thus becomes a source of knowledge and part of the therapeutic process.

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There were also however, several other non-electronic sources of knowledge

acknowledged by interviewees. They included: “newsletters”, “journals”, “books”,

“chat groups”, “local and international professional networks”, “seminars”, “cross-

functional workshops”, “help-desk” and “conferences”.

7.3.4.2 Electronic: The City Hospital Intranet

The main and popular electronic source of knowledge at the City hospital was the

Intranet. It is used several times a day by employees as indicated by the survey results

and supported by interviewees. The City hospital Intranet was the main means

through which the hospital shares: “information with its employees” and was used to

access: “the latest goings on” in the hospital and to relay: “announcements”.

Interviewees mentioned that: “having worked in a range of health sectors, the Intranet

is far superior to most I have used”; “it is a great medium for making information

widely available” and “a means of unifying communication within the organisation

and access to information”. An interviewee whose job role included the management

and provision of state-wide services explained: “I know we do a lot of transmitting of

video-CD’s, so I think that sort of thing is happening more from the clinical arena to

share lectures and clinical information with their peers over the Intranet for

example”.

Interviewees in response to features of the City hospital Intranet used revealed their

daily usage of its numerous features and links to software applications. Examples

include the: “E-mail” and “Quick links” features of the Intranet which an interviewee

mentioned: “provides us easy access to the various committees, groups and projects

in the hospital”. Some interviewees mentioned the use of the: “staff paging system”,

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and “departmental websites”. Other interviewees mentioned the use of: “knowledge

links” on the City hospital Intranet, including: “online databases for our guiding

policies and procedures”, “online discussion forums and common data repositories”

and “online best practice documents and meeting minutes” .

Other interviewees mentioned clinical software applications and knowledge-bases

such as the City hospital’s: “CIAP”, “online journal databases” popular with

clinicians, the: “online library”, “education and training manuals”, “videos” and self-

help support tools such as the: “eManager”. The automation of the library catalogue

on the Intranet: “made it possible for staff to access the library catalogue from their

desktops”. The release of the City hospital ‘ground rounds’ videos over the City

hospital Intranet was another example of how the Intranet was significant as a source

of knowledge by enabling as one interview noted: “non-metropolitan clinicians

access to educational resources otherwise only available at the main hospital”.

E-mail, a feature of the Intranet, was a particularly popular source of knowledge for

City hospital employees. Information aggregators such as: “the weekly all-user

communiqué” was mentioned as an example of an organisation-wide E-mail that was

sent out to employees regarding important news, announcements, directives and

developments. This kept knowledge flowing and dynamic at the hospital. An

interviewee mentioned: “I can store information I need in my inbox and refer back to

it whenever I need it”. Users also felt they could communicate using E-mail,

irrespective of their status or rank in the City hospital hierarchy. As an interviewee

pointed out: “I usually E-mail my director regularly and I feel much more comfortable

sharing issues using E-mail than I would talking”.

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Some interviewees however revealed the preference of talking to colleagues over

using E-mails: “We use a lot of E-mail correspondence and probably overuse it in this

organisation when you could just walk and talk to somebody”. Another interviewee

lamented: “I get a huge amount of E-mail… I think for a lot of people it’s

overwhelming. I can’t have any more than 10 days worth of E-mails and invariably

you can’t find quick reference to the E-mail, which becomes a problem. With the user

communiqué mass E-mail for example, I give blood and have occasionally missed the

blood bank because the E-mail is wrapped in this 20 bullet point circular that comes

around and I know that I should take the time to read through it”.

Interviewees also discussed various reasons for the widespread usage of the Intranet

for knowledge sharing at the City hospital. One explained that employees are:

“fortunate here that there is a computer on every desk”. Every interviewee agreed that

they used the Intranet daily and found it very relevant for their day-to-day activities. A

lot of praise was reserved for the IT department and IT support staff. One interviewee

explained, “We think very highly of the IT department and I don’t know how they do it

but they pick people with good people skills and personalities”. Another reason that

was mentioned was because of the direct communication of support from

management. One interviewee expressed: “this hospital lays great emphasis on IT

literacy, more so than any other organisation in the public health sector”.

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7.3.4 Usage of the City Hospital Intranet and its Impact on

Knowledge Sharing

In addition to the findings of phases one and two of the research, it was important to

get detailed views from interviewees regarding the role and impact of the City

hospital Intranet on knowledge sharing as represented by Nonaka & Takeuchi’s

(1995) knowledge conversion model. This composes the processes of socialisation,

externalisation, combination and Internalization. The findings are presented below.

7.3.4.1 Socialisation

The City hospital Intranet was able to facilitate the process of socialisation (the

sharing of tacit knowledge) by enabling creative and essential dialogue between users.

In response to how the Intranet supported the sharing of tacit knowledge, an

interviewee remarked: “I think it does because in E-email contact we build up a level

of trust and confidence in each others work so we bounce ideas of each other. It has

facilitated a lot of projects purely as a result of internal communications”.

Popular Intranet features that supported such interactions mentioned by interviewees

included: “E-mail”, “threaded discussions” from the online discussion groups,

“project pages” and “online work calendars”. As a medical doctor also explained: “in

this particular field, we have mail services that connect us to world-wide pathology

discussions. There is no question that it has revolutionised the way we work”.

.

7.3.4.2 Externalisation

The findings on externalisation (the conversion of tacit knowledge to explicit

knowledge) showed that the City hospital Intranet enabled dialogue between users.

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Several Intranet features enabled the sharing of subjective opinions such as E-mails,

paging systems and online discussion forums. The use of E-mail for example was

popularly highlighted for enabling dialogue and knowledge sharing. The sharing of

knowledge was however voluntary as one interviewee mentioned: “you may choose

to do it for specific purpose where your comments are vital”. Some interviewees

however admitted that they had not, as one noted: “reached that level of comfort with

the system as I don’t have time”.

Interviewees also pointed out that the City hospital Intranet was able to provide

pointers to expertise in the hospital in the form of: “employee profiles” available on

some departmental websites. The problem with the search functionality of the City

hospital Intranet as previously highlighted, limited its impact on the retrieving of

recorded information.

7.3.4.3 Combination

With regards to the process of combination (the combining of explicit knowledge to

create more explicit knowledge), interviewees agreed that the Intranet was used to

enable the synthesis and combination of knowledge from various sources in the

hospital. Various City hospital manuals, clinical and patient records, policies and best

practise as well as best practice reports were developed from different knowledge

bases available on the Intranet. This functionality as one interviewee pointed was:

“really helpful for our research units. Our reports are easily shared among employees

for e.g. via E-mail or on our departmental network”.

Collaboration with other employees over the City hospital Intranet also allowed newly

created documents to be shared and integrated. The new concepts thereby enriched the

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existing documents. The hospital Intranet gave unprecedented access to needed

information and enabled communication and collaboration on a larger scale never

done before witnessed at the City hospital. An interviewee's reflections are

illustrative: “it’s a powerful collaborative tool and my staff know that fully well”.

Another interviewee explained: “we are able to add pictures and movies to our

manuals to help share our experiences”. The hospital Intranet also enabled the

building of databases which was considered very important and as one interviewee

highlighted: “we have more databases than you can poke a stick at”. An interviewee

explained that they were able to use the hospital Intranet to: “extract data from the

databases and import data to it”. Another interviewee pointed out that: “the official

policies and procedures on the Intranet are the fundamental base of our knowledge”.

However as another interviewee admitted, there are time and maintenance constraints

involved: “the supply never exceeds the demand for databases and looking for new

ways of maintaining it. Our issue is maintenance. We are more fortunate than many

others but there are still limitations”.

7.3.4.4 Internalisation

The findings on the role and impact of the City hospital Intranet on the process of

internalisation (the conversion of explicit knowledge to tacit knowledge) showed that

users were able to learn by practising. They successfully adopted various Intranet

features such as online simulation and training programs. An interviewee commented:

“we have online flexible learning programs such as Pathlaw which is a learning

management system and we also use Walkaware”. These programs are available 24

hours a day and used for imbibing of new concepts as well as for experimentation

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with the pre-existing knowledge of users. An interviewee explained: “we use them to

test our knowledge in different scenarios…and for me it definitely enriches my

experience”. Users are also able to provide feedback on what has been imbibed, as

one interviewee pointed out “It has proven to be an extremely good source of

feedback which we didn’t expect”.

The use of these simulation and training programs was possible because as one

interviewee explained, the City hospital: “gives access to information it produces and

is not secretive about it”. Other interviewees however admitted that time constraints

made the utilisation of online training tools difficult unless it was mandatory or

necessary. This was highlighted in an interviewee’s remark: “unless we have to, we

don’t have staff willing to give the time and effort to facilitate such practices”.

7.4 Key Influencing Factors Affecting Usage of the City

Hospital Intranet for Knowledge Sharing

Public sector organisations including hospitals have distinct characteristics as well as

equally unique organisational conditions. This chapter presents the findings on the

key influencing factors identified from the literature and identified by interviewees as

affecting the usage of the Intranet in the City hospital.

There were several factors previously raised in the questionnaire-based study that

required further investigation. Some of the issues identified were about certain

features of the Intranet as well as other key difficulties users mentioned that impeded

the usage of the City hospital Intranet fir knowledge sharing. These difficulties could

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be classified as technical problems, inherent in the Intranet and non-technical

problems faced by users. The following identified factors are discussed below.

7.4.1 Technical Barriers

7.4.1.1 Search Functionality

There was a general consensus with regards to the ‘search’ functionality of the City

hospital Intranet. This was highlighted as a major problem that affected the quick and

easy location of the required relevant information. Questionnaire results showed that

the search functionality was not working as well as users expected. Results from the

interviews also showed that the main complaint associated with the usage of the

Intranet was focused on the ‘search’ functionality. As one interviewee mentioned:

“sometimes it’s difficult to search because it doesn’t always bring what you specify to

the top of the list”. This is especially critical as the work context is one that is

characterised in most cases by the need for rightly-informed, decisive and timely

decisions.

Closely related to the concern over the search functionality was the feeling by

interviewees that overwhelming amounts of information were being provided on the

City hospital Intranet with frequent changes (e.g. constant changes to policies and

procedures). As one interviewee mentioned, this was making it: “difficult for people

to sort through it”. Another explained that there was a need for: “having better

guidelines for what is good information and readability”.

In addition, interviewees also mentioned that some departmental sites were not always

up-to-date. According to an interviewee: “it creates a problem of irrelevance when

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certain things are not updated”. As interviewees mentioned, the effect of information

not being up-to-date affects the effective usage of the Intranet. One interviewee

mentioned this is because they are: “constantly being sought to retrain people as

they’re only going to be as good as the policies and procedures we provide them

with”.

7.4.1.2 Inability to Personalise Individual Intranet Websites

This research also discovered that a major barrier affecting the usage of the Intranet

faced by users was the inability to personalise their Intranet web pages, for example

with a: “favourites frame where we can specify links to the pages that we use most

frequently” and “shortcut keys for the most heavily used features”.

An interviewee remarked that this ability would: “give me a stronger sense of

attachment to it”. Another interviewee explained: “To me there are fundamental

differences between simply applying technology and its functionality like a David

Jones store where people find what they need rather than what the provider has to

give”.

Most interviewees lamented the rigid nature of the Intranet, with one remarking:

“We have strict document control over the works that we publish whether it is in

paper form or on the Intranet. Our treatment protocols have all been approved by

certified doctors that have a review process to implement changes. We don’t seek a lot

of variety and customizable options simply because of those strict control methods.

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For the less non-clinical things like contact numbers, we feel it is important to have

those customizable”.

7.4.1.3 Layout Structure

The results of the interviews conducted showed that many interviewees felt that the

structure of the City hospital Intranet was quite good. While the questionnaire results

had shown that about fourteen percent of respondents had seen it as an impeding

factor, there was a general agreement that the standardised layout and content

presentation was appropriate for the type and size of the organisation. As an

interviewee expressed: “I would say it’s centralised and it’s outstanding in my

opinion due to the size of the organisation”. Interviewees also pointed out the

improvements in the new Intranet compared to the old Intranet, as an interviewee

stated: “The way that the Intranet is set up currently is that it is easy to navigate, more

stylish, before it was quite clunky”.

There were interviewees however, that felt that the information they wanted to present

on their departmental/unit sites were restricted by the standardised layout structure of

the Intranet. Some departments felt that they had more relevant information to

present, as one interviewee put it: “It’s a bit rigid especially for something like ours

that could be really informative”. Others also felt that: “For the Intranet to be useful

its content must be managed at the level at which it is generated”. This rigidity led to

a particular City hospital unit setting up its own website without the knowledge of the

IT department, as the unit manager explained: “We have patients that come through

for x-rays and surgery and we have to have access to that information...so our main

reference point is the website that we have created”.

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7.4.2 Non-Technical Barriers

7.4.2.1 Lack of Time

Interviewees stressed that time pressure that felt as part of the day-to-day work

activities was a major factor that impeded the usage of the City hospital Intranet. Time

was usually prioritised for tasks related to primary job roles or tasks in the hospital.

As an interviewee stated: “I don’t think we've done enough to maximise the potential

of the Intranet as we don’t have staff willing to give the time and effort to facilitate

that movement”.

The supposed lack of time was also a major reason that interviewees gave for not

attending the training sessions provided by the IT department in the usage of the

various IT tools including the Intranet. Some felt that there was a need for top and

middle management to continuously reinforce the importance of the Intranet and KM

activities such as knowledge sharing. Others stated that it was not a question of not

‘having’ time but seeing the value and need to ‘make’ time. As one interviewee

maintained: “people will make time if it has a great priority or one is forced by

management”.

7.4.2.2 Training

Closely linked to time as an impeding factor affecting the usage of the Intranet was

the issue of a lack of training. As an interviewee explained: “I think lack of training is

a major barrier, you know the time for training is the real issue. You have to put it

into perspective of why we are here. Some people perceive the IT systems as a source

of information without realizing the potential they could discover through proper

training”.

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Interviewees reported that even though the Intranet was viewed as a knowledge

source, it was done without: “…Realizing the potential one could discover through

proper training”. Most of the interviewees however agreed that the effective usage of

the Intranet, including taking advantage of its benefits and potential depended on the

users themselves. One interviewee explained: “I suppose its only going to be as good

as the people who are using it”.

The lack of being effectively trained was identified to have an impact on the skill

level needed by some employees at the City hospital to effectively use tools such as

the Intranet: “The confidence and skill of other users becomes a barrier because some

people are weary about using it as a medium for communication or a research tool”.

While interviewees admitted that training sessions were regularly provided, many

again confessed that the previously mentioned pressure of time prevented their

participation. Some referred themselves to the FAQ’s or guide books whenever the

need arose, as interviewees explained: “Often we follow what I call a just in time

training. There are a lot of on-line services such as How To sheets and Frequently

Asked Questions so that anyone with a moderate level of knowledge can access them”.

“Training is a problem because of executive lack of buying, we get new

doctors in on certain times and I think we get two hours to train those doctors

in using the information systems and things happen…Like if we need to train

the staff on using the calendar the head of that department might refuse saying

we’re too busy”.

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7.4.2.3 Lack of User Awareness of Benefits

Interviewees disclosed that the lack of awareness as to the benefits and potential of

the Intranet was also identified by interviewees as a factor impeding the usage of the

Intranet for KM. For example, many of the interviewees did not know what the

objectives of the Intranet were. As interviewees acknowledged:

“I think the fundamental problem is a lack of awareness. If you know

something useful exists you will be motivated to discover more and attend

training to learn new things but many are just blissfully unaware”.

“I’ll give you a few examples. I think we have a lot of departments doing

fantastic things but not knowing or planning in a limited fashion. We do not

prioritise or plan in an integrated way so I think there’s a great opportunity

for the Intranet to solve these problems”.

One interviewee, echoing the view of others, believed awareness was a factor that

affected usage: “I don’t think we know as much as we should”. One felt that there was

an important need to: “educate people on the potentials of the Intranet”. Many

mentioned that they were not clear on: “what the knowledge management objectives

of the Intranet were”. As one interviewee who is involved in a hospital project

explained: “they won’t see how the information we collect lead to other things”.

All interviewees agreed that the lack of awareness of knowledge available on the City

hospital Intranet would have a significantly negative impact on their deliverables and

ultimately on the quality of service provided by the hospital. As one interviewee

expressed: “in some cases it stops you from making the best decision possible. It

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means the hospital has to pay money for things that would have been avoided with a

little extra information”.

7.4.2.4 Professional Resistance

Professional resistance among medical practitioners was disclosed as impeding the

usage of the Intranet in the City hospital. As one medical doctor reiterated, this

resistance could be due to the user professional backgrounds because: “like I said

before, medicine is an oral tradition” and many healthcare professionals share and

enhance their knowledge through collegial talk.

Although most of the interviewees agreed that a lot of the users were comfortable

enough with IT to use the Intranet at the City hospital, others suspected that some of

the users had insufficient skills and training to enable proper Intranet usage. One user

admitted: “I appreciate the extent of its accessibility but it comes back to user

deficiency”. An interviewee remarked: “it depends on the employee and the level of

the employee and their education”. Another interviewee stated: “I think having the

expectation that you will use and maybe overuse the Intranet depends on how well

trained you are but that’s not inclusive of everyone in the hospital”. For senior

medical doctors, not being familiar with the Intranet could lead to a sense of

scepticism and resistance to learn as one pointed out: “senior doctors suffer greatly

from the awareness issue and that’s because it is difficult to return to training”.

7.4.2.5 The Lack of a Clearly Defined KM Strategy

Interviewees acknowledged that there was the lack of a clear and articulated KM

strategy to guide the usage of the City hospital Intranet, particularly for knowledge

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sharing. Some managers had ad-hoc programs in place, as one admitted: “it does exist

I guess to a degree. For things like occupational health and safety there is a risk

management framework so in terms of that, there is information in terms of manual

handling, risk assessment, occupational health and safety, but not really in terms of

what you’re after…So I guess that information is out there but not wrapped up or

shared in any kind of coordinated plan”.

Others participated in what could be classified as KM initiatives but under different

labels: “we do have such a framework but it is more naturally present and doesn’t

exist under that name for us” while some were not even aware of any KM framework

at all. One interviewee explained: “well I’ve heard of knowledge management before

but I don’t know what it is. If you include things like learning management systems,

we do use those sorts of tools and we’re also developing some expertise and skills in

the use of E-learning. As far as knowledge management, hospital- wide, I know the IT

department is looking at a whole lot of issues to do with management databases,

capturing and evaluating information. I know that’s important here... We’re always

looking at improving our services and that seems to be the way to do it”.

7.4.2.6 Inadequate Staffing and High Staff Turnover

The lack of assigned staff with clearly defined roles and responsibilities in terms of

KM within individual departments/units was regularly reiterated by interviewees as an

issue that impeded effective Intranet usage. One interview mentioned that: “there

needs to be a commitment on behalf of the hospital in terms of money, time and

personnel to realise the full potential of the Intranet”. Other related comments echoed

by interviewees were that: “obviously it’s a question of time and staff”.

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The effect of not having dedicated staff to maintain Intranet content in particular plays

a key role in the usage of the Intranet. An interviewee explained: “the problem is

irrelevance when certain things are not updated”. However, interviewees did admit

that the lack of time and dedicated staff was a key cause of that: “I don’t think we can

expect every department to do that but it should be a hospital resource to have

someone responsible for that…to go around and liaise with other departments”.

As previously mentioned in the development of the City hospital Intranet (see chapter

5, section 5.4.4.2) in ensuring user involvement and addressing the problem of

keeping the hospital Intranet content up-to-date, each individual unit/department had

employees who were designated as IT contacts. These contacts had the authority to

update information on their individual websites and were to ensure an open line of

communication with the IT department about needs and requirements. Interviewees

saw this approach as very effective with one declaring that: “I think things have

improved though with the meta-data thing and the fact that we have very good IT

contacts in every department. They update things often enough”. A nurse explained:

“should we need to update the operation table one of our people in the department

can discuss it at a level that is feasible when working with others”. Conversely

however, one interviewee remarked: “it seems that…not all departments focus on this

responsibility”.

An interviewee who was an IT contact suggested that their busy work schedule made

it hard to balance both roles in the unit. He remarked: “I can only check that authors

have updated their documents when I have time, even though we have an automated

reminder sent out. Its choc-a-bloc [busy] here and I can’t be chasing them when I

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have deadlines to meet”. Another IT contact suggested that the role had turned him

into: “the IT support guy in this department...I don’t mind that, but it’s not my

responsibility here”.

7.4.2.7 Influence of Political Policies

The New South Wales (NSW) State Government upon review of the State health

systems announced a major restructuring of the State's health administration. This

included the amalgamation of seventeen area health services into eight area health

services across the State. Rumours had been spreading around at the hospital that it

would lose its independence and would be amalgamated with one of the area health

services. This was viewed very negatively by employees who felt that such a

development would adversely affect the administration of the hospital and its

provision of services. These rumours as an interviewee explained have: “clearly

affected the morale of the staff” at the City hospital. The employees here, another

interviewee emphasised: “strongly cherish the independence of this organisation, this

is as a key reason I believe that we are efficient, innovative and quite successful”.

Another interviewee in agreement stated: “we are in a state of flux at the moment.

These rumours had made us staff feel vulnerable and many are beginning to question

what future they would have here should it fall under regional administration”. Some

employees it was revealed are therefore: “starting to look at other options such as

alternative employment”.

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Another interviewee added: “you can feel how this affects staff… How can we focus

on day-to-day activities and how can we use the Intranet to communicate as one

doesn’t know what structure we will have tomorrow”.

7.4.3 Enabling Conditions

As concluded from the literature review (see chapter 3, section 3.6), a culture that was

conducive to knowledge sharing and a decentralised governing structure were key

enabling conditions for the usage of the Intranet for knowledge sharing. The results of

the interview findings regarding these two factors are presented below.

7.4.3.1 Knowledge Sharing Culture

The questions on culture were designed to investigate whether the culture at the

hospital was conducive to knowledge sharing and if so, in what ways. The following

measurement factors used by Lee & Choi (2003) were adopted, modified and

examined: value of knowledge sharing and willingness to share; organisational

promotion and support for knowledge sharing; rewards for knowledge sharing as well

as investigating departmental and organisational cohesiveness (viewing the

department and hospital as one team). The findings and discussions are presented in

the following subsections.

7.4.3.1.1 The Value of Knowledge Sharing and the Willingness to Share

A main reflection of the comments of the interviewees showed that the employees at

the hospital valued knowledge sharing very highly, particularly in comparison with

other hospitals. An interviewee stated that: “if I was to compare it with other

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organisations I think we’re very well off” and interviewees also agreed that the

Intranet plays a key role in increasing the value of knowledge sharing among

employees. As one interviewee acknowledged: “at our old campus in Camperdown

they had a smaller area and number of employees, 1,500 full time employees and it

was easy to share knowledge when bumping into one another. Here however, we have

over 3,000 full time employees and there is no main street. The Intranet is the main

street”.

Another common comment reflective of most was that: “people that come across

relevant information would be willing to pass it on to colleagues”. Interviewees felt

that the factors that facilitated this valuing of knowledge sharing were based on, as

one pointed out “the view of this being a teaching hospital”. This was reflected on the

City hospital Intranet, as one interviewee revealed: “Look at KidsHealth…We and the

Western hospital are the only hospitals that actually have their catalogues on the

web…KidsHealth is amazing and I think the hospital is proud of what it is and it loves

to share and give that information freely”.

It was also highlighted that the employee’s propensity to share knowledge depended

on the personalities of the individuals involved: “in our department we have people

willing to share and some who aren’t. I think individuals want to sometimes keep that

information to feel important and needed…I try to encourage the opposite of that but

if someone wants to keep the knowledge it’s hard to force them to share”. Some

interviewees believed the willingness to share also depended on the individuals

specialization or job roles within the hospital, seeing it as varying between:

“clinicians, nurses and administrative staff”.

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7.4.3.1.2 Senior Management Support for Knowledge Sharing

In response to the questions investigating senior management promotion and support

of knowledge sharing using the Intranet, interviewees felt that there was considerable

support and promotion of knowledge sharing from the senior management of the

hospital. One interviewee expressed that:

“we are very lucky that we have a culture in the organisation where the

examples are set by the executive and the CEO…There was a direction and I

guess its probably been in the hospital for a long time that if we’re going to go

electronic we’re going to go all in. So you get your information out there, you

don’t sit with hardcopies and I believe that that kind of uptake has been driven

by the executive”.

The support from senior management and managers was shown through the numerous

programs such as: “training courses and conferences” that were held at the City

hospital. These were followed through and the importance of the Intranet reiterated by

“senior management at numerous hospital events”. However, at the departmental/unit

levels, interviewees suggested that the impact of the departmental culture on Intranet

usage and knowledge sharing was mediated and influenced by managers or Heads of

Departments. One interviewee explained: “if some managers want to live in the dark

ages and if you have a strong leader in that department their culture controls the

culture of the whole department. Often the people under them are stifled”. Senior

management support was therefore viewed as crucial by all interviewees especially

since there was a need, as one interviewee said: “to promote a system that works

well”.

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7.4.3.1.3 Reward for Knowledge Sharing

Interviewees were asked if employees were visibly rewarded for knowledge sharing in

general and via the Intranet in particular and if not, whether they felt it was important

that they were. Interviewees admitted that employees were not specifically rewarded

for knowledge sharing at the City hospital although there was the: “employee of the

month” award given to staff members for their pro-active performance in work

activities. Interestingly, almost all interviewees agreed that rewards, especially

financial, were not necessary.

Interviewees explained that knowledge sharing at the hospital was viewed rather as an

expectation. An interviewee echoed the views of others saying: “I think it’s an

expectation…I think we’re all big people here and we’re professional so there is an

expectation to share and we derive satisfaction from that”. Another interviewee

pointed out: “I think if they work here they must try to contribute as much of their

knowledge is possible”. Another explained: “I think more or less it’s an expectation. I

have a problem with rewards because often the wrong people get rewarded and

there’s a big group behind good things and they don’t always get that reward. As long

as every one is acknowledged it is fair and well”.

The findings were evidence that employees at the hospital valued acknowledgements

and intrinsic rewards highly. Interviewees suggested that employees who were pro-

active in knowledge sharing in particular should be acknowledged and encouraged.

As one interviewee explained: “people should be recognized and given a pat on the

back for fulfilling that expectation of knowledge sharing”. Another interviewee

stressed that: “it would be great if it were encouraged more with little perks that

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support professional development…such as, study and conference leave,

encouragement to write and publish...such compliments would go along way to

encourage knowledge sharing”.

7.4.3.1.4 Viewing the Department and Hospital as One Team

Interviewees acknowledged that generally there was a positive culture felt at the City

hospital that impacted on the usage of the Intranet. This was due to a variety of

reasons. As one interviewee revealed: “being a children’s hospital we’ve always had

a different look and feel and it is a culture which has carried on from the old

organisation due to the family-oriented culture we promote. I believe this is

represented on our Intranet”. Therefore, being a children’s hospital played a key role

in the type of organisational culture at the City hospital. It was instantly noticeable

that the offices, wards and corridors of the hospital were made to be very children-

friendly with warm lovely colours, lots of beautiful paintings, entertainment areas and

resident clowns among other things.

All interviewees agreed that they viewed their departments as one team working

towards common goals. When asked about whether they viewed the whole

organisation as one team, responses were divided. Most did believe that the culture of

the hospital was one that fostered a team feeling: “the culture is like a big family

here”; “I think this hospital has got a very good team approach. A comment when we

had accreditation the other day was made about not going out and telling people how

great we are but you cant help feeling positive…There’s a very good feeling about

this place so yes I think it’s part of being a team”.

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Some interviewees felt that the hospital worked as a team with each part playing its

role in its own way: “my general impression is that this is a team and everyone really

has the good of the child at heart...whatever is best for the child everybody will do

their best to give that service”. Many felt that the feeling of unity was affected by

struggles for example, between the clinical and non-clinical departments for influence

and resources.

Others suggested that the feeling of unity could vary depending on when the situation

demanded it. Such as the annual external quality evaluation where the Intranet was the

key tool for organisational-wide coordination and knowledge sharing binding the

organisation together strongly. One interviewee declared: “the tribes come together

when they have to”. Another interviewee explained: “there are a number of silos

within the hospital but when it comes to the crunch then the whole hospital gives it a

turn”.

Interviewees however, stressed that in comparison with other public hospitals the

feeling of unity was much stronger at the City hospital: “I think we have a very strong

sense of unity, image and branding of all the other health services”.

7.4.3.2 Intranet Structure

Previous research suggests that IT tools that enable KM processes such as knowledge

sharing require flatter, loosely controlled or decentralised governing structures. It was

therefore important to investigate the structure governing the Intranet at the City

hospital and its impact on employee usage for knowledge sharing.

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7.4.3.2.1 Centralisation or Decentralisation

The question on the perceived structure governing the Intranet interestingly provoked

different responses from interviewees. A majority of the interviewees reported that it

was a combination of both centralised and decentralised structures: “it is sort of

balanced. There is a procedure framework…In an effort to manage the Intranet I must

stay within these guidelines and then must bring my own methods into it”.

Interviewees explained that the layout of the sites was standardized while content

management was left to individual websites: “well, each department is responsible

for their own site and some are of higher quality than others. Now with the

standardisation of the sites it’s much more centralised”. Another stated: “an example

is our policies and procedures during the centralisation of our information we

discovered several discrepancies in clinical practices. What we’ve done is get a multi-

disciplinary policy procedures group where we will make sure clinical practice

policies will have an owner and are updated at such and such time”.

Interviewees explained that this ability to update information by individual

departments had, as one interviewee put it: “certainly changed employee behaviour,

by giving them a stronger sense of responsibility and independence”. This also

eliminated the waiting period for minor changes that previously had to go through the

IT department and created a bottleneck. Many interviewees felt that the

standardisation of departmental sites reduced certain difficulties such as the:

“problems of navigation when looking for generic content”.

Some interviewees however, suggested that the structure governing the Intranet was

centralised. Those who believed it was centralised also differed on whether it enabled

or impeded the usage of the City hospital Intranet. Those in favour of the structure

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being centralised felt that the size of the hospital made it appropriate, as one

interviewee stated: “it’s centralised…and it’s good because we are a large

organisation”. Those who disagreed with the centralised structure suggested that it

created a lack of ownership, thus affecting usage: “it is very much a top-down system

and it’s therefore very hard for people to give feedback…I think people feel

disconnected from the set-up and control of the Intranet”.

However, others felt the need for more central management of the City hospital

Intranet content because giving more freedom to users to customize features or

modify layouts would make for example content difficult to find and sharing difficult.

As an interviewee stated: “I think it should be centralised because when a central

body is responsible for it you don’t have to worry about the updates. It has to be

managed centrally.” Another explained: “hmm well we have changed our front page

of our Intranet for accreditation purposes but I don’t think it would be wise to make it

permanently different. It would become too hard to find things”. There was also the

concern that it would lead to a lack of usage: “if we were to make the Intranet

customizable I’m afraid people won’t use it”.

7.5 Summary of Findings

This phase of the research aimed to gain an in-depth understanding of the issues and

patterns identified from the first and second phases of the study by investigating the

role and impact of the Intranet on knowledge sharing at the City hospital. Additionally

investigated were the factors influencing the usage of the hospital Intranet for

knowledge sharing. Semi-structured interviews were conducted with a sample

selected from the various strategic levels and specializations within the hospital.

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The findings on the definition of knowledge and KM revealed many varying

interpretations and understandings. Quite importantly, the findings also suggest that

employees were not all aware of the existence of the concept and its initiatives at the

City hospital. Some interviewees believed that it existed under different labels. The

interview findings also showed that different knowledge types (including tacit and

explicit knowledge) were shared at the City hospital. However, because of the

preference for collegial talk, tacit knowledge was more predominantly shared at the

hospital.

Interview findings highlighted two main and popular knowledge sources used at the

City hospital that could be categorized as electronic and non-electronic. The main

non-electronic source was ‘other people’ such as colleagues at the City hospital, while

the main electronic source was the hospital Intranet. The hospital Intranet was found

to have a significantly positive impact on organisational communication and

knowledge sharing at the hospital. Of the Intranet’s features, the E-mail was popularly

used for knowledge sharing. The findings revealed that it was used as a tool for

sharing, storing and accessing knowledge. However, the findings did show that E-

mails could also become overwhelming, resulting in employees spending considerable

time sifting through them.

Another key finding revealed from the research was that knowledge sharing varied

within and across departments at the City hospital. Within departments, the

collocation of employees and close working relationships meant knowledge sharing

was free flowing and resulted in the predominant sharing of tacit knowledge. This led

to a reduced usage of the Intranet for knowledge sharing, with usage focused on

storage for later access and sharing of knowledge. Knowledge sharing across

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departments was regarded at times to be ‘tribal’. Issues such as the lack of a shared

understanding, differences in job activities, needs and reduced personal relationships

across departments were reported to influence the usage of the Intranet for knowledge

sharing between departments.

However, the hospital Intranet was viewed by users as helping to promote awareness

of the roles and the importance of the different department/units through the increased

interaction facilitated by its usage. The hospital Intranet enabled access to other

departmental knowledge bases and allowed group communication among people in

disparate locations. Hence, making knowledge easily available, widely distributed and

allowing more people to be included in the knowledge sharing process. The hospital

Intranet was viewed by interviewees as having a strong and positive impact on

knowledge sharing across the hospital as a whole because of the key role it played in

this regard.

The interview findings also revealed the role and impact of the City hospital Intranet

on knowledge sharing reflected by the Nonaka & Takeuchi’s (1995) knowledge

conversion model processes of socialisation, combination, externalisation and

internalisation. These processes were able at varying levels, to be facilitated by the

advanced features and functions available on the Intranet. The findings showed that

the Intranet is able to support various forms of personal interaction (socialisation);

enable information shared by users to be collected and integrated into repositories

(externalisation); enable the capturing and integration of new explicit knowledge

(combination) and its advanced features could support the process of internalisation

through the imbibing of new concepts using online learning and simulation programs.

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Nevertheless, certain constraints were also highlighted. The poor search functionality

was a major technical difficulty that hindered the Intranet’s positive impact on the

knowledge sharing because users could easily find information that they sought.

According to the interview findings, key influencing factors affecting the usage of the

Intranet for knowledge sharing included technical (Intranet) and non-technical (user)

barriers. As previously reflected in the questionnaire-based study and revealed in the

interview findings, the major technical barrier faced by users of the City hospital

Intranet was the poor search functionality. This was closely related to the sometimes

overwhelming and outdated information made available on the Intranet. Another

technical barrier revealed by users was the inability to personalise individual views of

the Intranet restricting the type of information that could be provided.

With regards to the non-technical barriers influencing the usage of the City hospital

Intranet for knowledge sharing, interviewees viewed a ‘lack of time’ as the most

prominent barrier. Another impeding factor revealed from the interview findings was

the lack of training on the usage of the Intranet. This had also been highlighted in the

results from the questionnaire-based study. Additionally, in what could also be linked

to a lack of training, interviewees revealed that a lack of awareness of the benefits and

potential of the City hospital Intranet was a factor impeding its usage for knowledge

sharing. The goals and objectives of the Intranet were not clearly articulated and

communicated to the users. Professional resistance from health practitioners towards

the use the Intranet was also discussed by interviewees as a non-technical barrier

impeding the usage of the City hospital Intranet for knowledge sharing.

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Furthermore, interviewee responses identified crucial factors that impeded the

effective usage of the City hospital Intranet. These factors highlighted the sometimes

unique nature of the conditions faced by public healthcare organisations. Emerging

out of this investigation were several factors. These factors included the lack of a

clearly defined KM strategy, professional resistance to the usage of the Intranet, a

high staff turnover, a shortage of staff to hold clearly defined roles or responsibilities

for KM within departments/units as well as political policy changes affecting the City

hospital that creates a situation of uncertainty.

The influence of culture on the usage of the Intranet for knowledge sharing was

measured using four factors. These included the value of knowledge sharing and the

willingness to share; senior management support for knowledge sharing; reward for

knowledge sharing and viewing of the department and hospital as one team. The

results of the interviews showed that Intranet users at the City hospital valued

knowledge sharing and there was an overall willingness to share. This could be

attributed to the high educational levels and specialized skills of employees as well as

the educational environment of the City hospital (being a teaching hospital).

Interview findings also revealed that Intranet users viewed senior management as

publicly supporting knowledge sharing, including the usage of the Intranet to facilitate

it. The interview findings on whether rewards were necessary suggest that while users

agree that acknowledgements should be given they did not have any preference for

financial rewards. The findings also showed that interviewees regarded their

departments as one team. Although this could not be always said for the whole

organisation, nevertheless interviewees felt the hospital as a whole was united on the

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basis of the overall goals and objectives of the hospital (e.g. the provision of care to

sick children).

Interview results revealed different views on the structure governing the Intranet. A

majority of interviewees described that it was a combination of a centralised and

decentralised structure while some perceived it to be centralised. Interviewees were

also divided on the benefits of the existing structure. Some users believed it to be a

key enabling factor influencing usage of the City hospital Intranet for knowledge

sharing. Conversely, others found it restrictive and an impeding barrier to its usage.

The following chapter presents the discussion of the findings from the three phases of

the research, the contributions of the research, research limitations and the

conclusions of the thesis.

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Chapter 8-Discussion and Conclusions


This chapter presents a discussion on the findings of the empirical studies carried out

as part of this research and the conclusions of this thesis. It is divided into the

following sections. Section 8.1 presents the discussion of the main research findings

while section 8.2 highlights the major contributions and implications of the research

based on the main findings. Section 8.3 reflects on the research by addressing its

limitations and suggesting directions for future research. Finally, the thesis

conclusions are presented in section 8.4.

8.1 Discussion of Main Research Findings

The aim of this thesis is to provide critical insight into the usage and impact of the

Intranet on knowledge sharing in a public healthcare organisation. The research

setting selected was a large public children’s hospital characterised by knowledge-

intensive day-to-day activities that were critical and emergent in nature. These

activities are often performed under immense stress and time constraints by highly

skilled and knowledgeable workers (Atkinson, 1995; Ellingsen, 2002).

In order to address the aims of this thesis, a review was carried out synthesizing

several bodies of literature including but not limited to the IT, public sector

management and health/medical informatics literatures. The following four key

research questions comprising of the following aims were thus formulated:

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a. Investigating the type, technical specifications and features of the Intranet

in use at the hospital.




d. Investigating the goals and objectives set out for the usage of the Intranet

at the hospital.



a. Investigating the types and sources of knowledge shared within the

hospital and via the Intranet in particular.

b. Investigating the key mediums for knowledge sharing used in the

hospital.

c. Investigating user experiences and patterns of usage of the Intranet

among users in the hospital.

d. Identifying the key factors influencing the usage of the Intranet,

including user opinions on the factors that facilitate or impede its

usage.


This question had the following aims:

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a. Investigating user opinions of knowledge and KM, particularly



c. Investigating the impact of the Intranet on the knowledge sharing

processes represented by Nonaka & Takeuchi’s (1995) knowledge

conversion model.

4. What are the factors influencing the usage of the Intranet for knowledge

sharing within the hospital?

Of particular interest was the need:

a. To investigate the key difficulties impeding the usage of the Intranet at

the hospital.

b. To investigate the influence of culture and structure on the usage of the

Intranet for knowledge sharing at the hospital.

In addressing these questions an in-depth three-phase exploratory case study in the

selected public hospital (referred to as City hospital) was carried out. The case study

incorporated a combination of mainly face-to-face interviews and a questionnaire-

based survey. This was further supplemented by personal observations, usage and

features demonstrations of the Intranet and a review of key hospital documents (e.g.

annual reports, strategic plans and Intranet logs).

The first phase presented an overview of the City hospital with a detailed

investigation of the Intranet technology used at the hospital. A review of the Intranet’s

history and development, the challenges faced in its implementation and how these

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challenges were addressed was conducted. An overview of the many advanced

features and applications of the City hospital Intranet was also presented. This

provided an insight into the nature of the Intranet and its expected role in the

achievement of the goals and objectives of the hospital. The second phase of the

research included the administration of an online quantitative survey and a review of

strategic documents related to the Intranet and its usage in the hospital. Finally, the

third phase included the carrying out of 50 semi-structured interviews with actors

drawn from various levels and specializations within the hospital. These included

senior executives, doctors, nurses and general users.

An exploratory case study was considered appropriate because it allowed for the

immersion of the researcher in the research setting, providing greater in-depth insight.

The research methods adopted facilitated the exploration, capturing, as well as the

understanding of the context, the feelings and perceptions of the participating actors.

The main findings from the research questions are summarised in the following

sections.

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8.1.1 Research Questions Revisited

8.1.1.1 Research Question 1


An important finding revealed in the first phase of the research was the identification

of the type of Intranet implemented at the City hospital. The investigation showed that

the hospital Intranet was not one of the four distinct types of Intranet proposed by

Goles & Hirschheim (1997). Rather, it was an advanced and hybrid combination. It

therefore included information publishing applications, informal collaboration

applications, transaction-oriented applications and formal collaboration applications

types listed by Goles & Hirschheim (1997). The findings highlighted the advanced

features and rich functionality of the Intranet, as previously mentioned by Majchrzak

et al. (2000). This in turn makes it a suitable tool for effectively supporting KM

particularly knowledge sharing, as highlighted by Damsgaard & Scheepers (2001).

This ‘maturity’ of the Intranet (Riggs et al., 1994) at the City hospital therefore

enabled it to play a significant role in the achievement of excellent delivery of care.

The Intranet was able to provide a unified view of the hospital’s knowledge resources,

encompassing its people, the organisational structure, its critical knowledge bases and

applications (both clinical and administrative) among many others. Its numerous

advanced features facilitate the ease of access to and sharing of hospital news and

communications (e.g. all-user communiqué), collaboration between employees

through its features e.g. online paging facilities, E-mail and online discussion forums.

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The findings of this phase importantly revealed key success factors that facilitated the

implementation and widespread adoption of the City hospital Intranet. These factors

can be classified as technical and non-technical success factors. The investigation of

the Intranet showed that it had evolved from an older version. It was also regularly

used across the various levels and specializations within the City hospital (e.g.

medical, nursing, clinical and corporate/support). One technical success factor

involved the development of the new Intranet to offer better accessibility and

usability. Usability can be defined as the effectiveness, efficiency and satisfaction

with which users can achieve tasks in a particular environment. High usability means

a system is easy to learn and remember; efficient, visually pleasing and fun to use;

and quick to recover from errors (Ginsburg & Pusedu, 2001). A good layout and ease

of use are both considered important usability factors (Begbie & Chudry, 2002).

Therefore, in the development of the new Intranet it was considered important to

ensure that it was easy to use and navigate if it was to be widely adopted by users.

A key technical factor that facilitated the implementation of the new Intranet was the

scalability. This enabled it to overcome the technical challenge of moving from an old

to new architecture. New users, hardware, software and processes at high performance

levels could be easily added. The old Intranet architecture could therefore be

improved, expanded and developed into one that was better integrated and

encompassed more advanced features. Thus, the Intranet was able to seamlessly

aggregate knowledge from disparate sources through various software application

tools. For example, its new CIAP application enabled the provision of patient

information records. This was achieved through the streamlining of patient

information from admissions, beds availability, billing and medical records. The

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hospital Intranet also provided online training, education and several support services.

These services included HR, finance and food services like the popularly accessed

online canteen menu.

The existence of a very supportive IT department proved to be an important non-

technical factor that supported the widespread adoption of the Intranet. Users of the

City hospital Intranet were able to benefit from an IT department with dedicated sub-

units that was adequately staffed. The IT department provided access to the resources

needed by IT contacts and users. Sarnoff & Wimmer (2003) point out that the more

the IT tool is tied to the user’s needs, the more likely it would be widely used.

Another significant non-technical success factor was the role played by the IT

contacts designated in each department. They promoted user involvement in the

development, implementation and administration of the Intranet. These IT contacts

ensure an open line of communication with the IT department regarding individual

department needs and requirements. They are responsible for quality control and the

regular publishing of relevant and critical knowledge content on their individual

Intranet websites. These IT contacts are also members of a web-steering committee

that oversee the administration of the hospital Intranet. Such committees give users a

sense of ownership (Kirby, 2006) and make them feel ‘involved’ in the development

of the hospital Intranet. It was also crucial to the usage and impact of the hospital

Intranet as IT contacts met frequently. These regular meetings helped to develop both

working and personal relationships. This lead to the creation of knowledge links

through IT contacts and cross-functional awareness of the contributing roles and

needs of other departments.

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IT contacts were thus able to play a role in reducing functional/departmental barriers.

This was possible through the awareness of how the different individual departments

contributed to the overall goals and objectives of the City hospital. They were then

able to share this with their departmental colleagues. The research findings also

showed that IT contacts worked closely with the IT department. Technical changes

and needs were promptly implemented and addressed. These findings suggest, as

highlighted in previous research (e.g. Kirby, 2006; Lamb & Davidson, 2005; Miller et

al., 1998; Rosen, 1998), the crucial need for a cross-functional committee to be

responsible for overseeing the implementation and development of the Intranet,

especially with regards its usage for KM activities.

Al-Gharbi & Alturki (2001) citing Gonzalez (1998), stress the need for users to be

involved in the design, development and implementation to increase user satisfaction.

Accordingly, it was crucial to avoid the counterproductive aspects of the traditional

method where IT specialists work in isolation and deliver a ready system to

employees to use. This was particularly vital as success was dependent on wide

support especially from the main work groups (e.g. nurses and clinicians). Lamb &

Davidson (2005) in support also saw strong evidence to suggest that mixing the roles

of content owners, developers, and users allows for the technology to be applied and

adapted to local use contexts and is a key ingredient for success. Miller et al. (1998)

explain that a corporate-wide committee responsible for policy and strategy

development is helpful in setting overall strategy. It allows for the devolution of its

implementation to specific website groups. Rosen (1998) showed how Microsoft used

‘evangelists’ in strategic groups to inform employees that the Intranet was the new

medium for sharing information.

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In the second phase of the research it was revealed that users utilized, in addition to

the Intranet, a variety of knowledge sharing mediums. There was a popular preference

for collegial discussion as the means for knowledge sharing. According to

Gramatikov (2004), one of the characteristics of managing knowledge in the public

organisations is the presence of extra sources and transformers of information. This

view is supported by previous research (see for e.g. Berg & Toussaint, 2003; Dawes

& Sampson, 2003; Alberdi et al., 2001; Lamont, 1993), suggesting that healthcare

professionals use multiple sources of knowledge, with verbal communication amongst

colleagues being one of the mainly preferred sources. Furthermore, this also expresses

the type of complexity that could exist within a large hospital due to the frequent

usage of different knowledge sources and mediums to share knowledge. Accordingly,

it could enable the development of shared meanings among the participants involved

(Ruhleder & Jordan, 2001).

The two main mediums used at the City hospital could be categorized as non-

electronic and electronic. The main non-electronic medium of knowledge sharing was

‘talking’ with other people. This occurs in meetings (formal and informal) and over

telephone calls. Haldin-Herrgard (2000) claims that the most common way of creating

and sharing tacit knowledge is face-to-face. It could therefore be viewed as the

popular medium for enabling the sharing of tacit knowledge, which is deeply

embedded in behaviour and work contexts (Woodcock & Reinema, 2001). The City

hospital Intranet was the main electronic medium for knowledge sharing. The most

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popular feature used was E-mail communication. This was seen as the main facilitator

for the sharing of explicit knowledge and connecting knowledge seekers with

knowledge sources.

The nature of healthcare practitioners regularly engaging in a lot of collegial

discussion could be linked to the poignant point raised by a medical doctor

interviewee who stated that the medical profession has an ‘oral’ tradition. Hospital

physicians in particular are estimated to spend between fifty to sixty percent of their

time devoted to talk (Brown et al., 2004; Coiera, 2000). It was therefore apparent that

informal and ‘tacit’ knowledge sharing was more prevalent at the hospital. This could

be due to the dynamic nature of the work carried out at the hospital and the personal

relationships created from such constant interactions, allowing for the sharing of

opinions and experiences. For example, the ‘grand round’ culture of doctors and

clinicians discussing patient cases while walking around the wards or corridor chats at

the City hospital meant that as a consequence, there was a significant amount of ‘tacit’

knowledge sharing occurring informally without recourse to the hospital Intranet.

Previous research by Lenk et al. (2002) provide supporting evidence for the findings,

explaining that the knowledge shared and used in public organisations is usually

unstructured and hard to process and computerize. According to Earl (2001), it

provides the opportunity to meet people you do not need to interact with formally, to

reflect, exchange ideas or to break out of the office environment. It also encourages

socialisation as a means of knowledge sharing. The organisations corridors become a

magnet for unanticipated encounters and conversations and a good place for meeting

people. It allows for unprompted conversations, leading to the exchange of surprise

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information, hidden ideas or the discovery of hitherto unknown expertise. It is also a

space where quick messages can be exchanged or further meetings arranged.

Researchers (Brown et al., 2004; Dawes & Sampson, 2003) conclude that one reason

for this pattern by healthcare professionals (e.g. medical doctors making use of

consultations with colleagues) is in an effort to answer questions quickly and

conveniently. Brown et al. (2004) suggest that another reason is a preference for

knowledge seeking from trusted people and because conversations allow for the give

and take of ideas. The emergent and dynamic nature of the work carried out in the day

to day activities of employees at the hospital leads to close interaction. Employees

trusted and consulted one another regularly, developing personal relationships. Dawes

& Sampson (2003) add that this might be reflective of a psychological need for

reassurance as well as the need for tacit knowledge that embodies the experiential

knowledge of the individual.

Traditionally however, according to Van Beveren (2003), knowledge sharing between

healthcare professionals has tapped both explicit and tacit knowledge sources. The

educational training provided at universities transfers the explicit knowledge and this

continues within the healthcare organisation’s various policies, procedures and

manuals that embody explicit knowledge. Moody & Shanks (1999) explain that each

hospital defines its own procedures for handling particular types of cases (e.g. cardiac

arrest) and these clinical policies and protocols play a critical role in medical practice

(Wilson et al., 1999). The transfer of tacit knowledge occurs through apprenticeship-

style work patterns such as the grand rounds mentioned earlier where junior doctors

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work alongside a senior doctor or clinician around the wards discussing patient

ailments, or participate in the performance of surgery.

It has however been pointed out that errors in tacit knowledge sharing (for e.g. face-

to-face communication) have been responsible for errors in healthcare provision

(Brown et al., 2004). The City hospital Intranet could help to act as a central

repository for sharing and storing knowledge that is able to be scrutinized in order to

promote its integrity. The results of the daily usage frequency of the hospital Intranet

suggest that it was a popular tool with a majority of users accessing it several times a

day. This was consistent with the fact that the hospital Intranet was the organisation-

wide knowledge ‘nerve centre’ of the hospital and was the primary means of receiving

organisation-wide news and information. This was also supported by the data

gathered from the Intranet log files as reported in the first phase of the study as well as

from the results of the questionnaire-based study.

However, the relatively short time spent using the Intranet over a week would suggest

some inconsistencies. Shorter time spent using the Intranet would also mean less time

spent using the different features of the Intranet for knowledge sharing. It could be

that this relatively short duration of usage is due to the nature of the critical and

emergent work at the City hospital placing time constraints on prolonged usage. It

could also mean problems associated with the usage of the Intranet due to bad

features, functionality or the lack of speed preventing longer usage.

The most commonly used feature of the Intranet used for knowledge sharing at the

hospital was E-mail. It was viewed as a means for easily communicating with other

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users. It was also a popular source of knowledge for hospital employees. In addition,

users could use their E-mail program to store and access knowledge. Chambliss &

Conley (1996) in their study of assessing how physicians responded to clinical

questions found electronic sources to be their primary source of knowledge.

Moustakas et al. (2006) further states that E-mail has emerged as a major means of

personal and corporate communication. Other researchers such as Lee (1994) and

Ngwenyama & Lee (2002) suggest that E-mail enables a rich form of communication.

Furthermore, Lee (1994) for example notes in the study of managers’ use of E-mail,

that communication using IT involves the creation and interpretation of symbols by

human beings, rather than just the physical transportation of bits through a conduit.

The findings also showed that communication features of the City hospital Intranet

such as the online paging system and online phonebook were popularly used. The

Intranet was approximately equally used when accessing knowledge documents and

databases, clinical application software such as CIAP, on-the-job training programs

and obtaining information about other departments.

The questionnaire findings revealed that respondents found several aspects useful and

important about the City hospital Intranet. It was viewed as facilitating

communication and collaboration due to its various features. For example, this

included the ability to arrange online bookings, job requests, online setting up of

meetings, sharing of project best practices, online discussion forums, document

versioning and the updating of documents or other content published online.

Respondents also found the Intranet to be useful and important for online training and

education through the various multimedia online training and educational courses

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available. It was also evident that certain websites, such as the cafeteria website of the

hospital Intranet, were also popularly accessed by users.

The questionnaire findings also showed that there were common comments on factors

that respondents felt act as barriers to the usage of the Intranet. Problems associated

with the search functionality of the City hospital Intranet was revealed as the most

common complaint. The increased size of the Intranet had created the need for a faster

and more sophisticated search engine. The lack of consistency regarding information

presented on departmental/projects websites also made searching more tedious.

Another common factor that respondents mentioned as impeding the usage of the

hospital Intranet was the lack of time available to learn and make appropriate use of it.

This was also referred to as ‘time constraints’ or ‘time pressures’. Moreover, a lack of

training and knowledge of the usage was also noted as another impeding factor.

Respondents mentioned a rigid adherence to the layout due to what many considered a

centralised structure governing the Intranet.

Respondents also highlighted that the structure of the City hospital Intranet content

impeded its usage. Two major factors regarding the content included information

being out-of-date and ‘information overload’, a popular term for referring to when too

much information is made available to the user. While an automated document

versioning system notified the document author when it was nearing expiration or had

expired, a lack of follow up could be linked to time constraints, which could be

viewed as further evidence of it being a key impeding factor.

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In investigating knowledge sharing at the City hospital, it was important to gain an

understanding of the Intranet users’ perception of knowledge and KM. In the third and

final phase of the research, the research revealed different definitions and

understandings of knowledge and KM. This can be seen for example where an

interviewee talks about knowledge being based on the particular needs and roles of

the users at the hospital. This could be due, as Bosua & Scheepers (2002) explain, to

different workgroups, departments or business units relying on different situation-

specific knowledge within the organisational setup. Knowledge is therefore viewed as

something tacit, subjectively personal and highly dependent on the context in which it

is produced (Martin et al., 2003).

The interview findings also importantly showed that not all employees were aware of

the existence of KM initiatives at the hospital, particularly the usage of the Intranet to

support such initiatives. KM initiatives existed but under different labels and at

varying levels within the hospital. Although it could be argued that: ‘what’s in a

name?’ there was a lack of a clearly articulated KM framework strategy at the City

hospital including one addressing the usage of the Intranet for supporting KM. The

lack of a KM strategy in public organisations has been highlighted in previous

research. Cong & Pandya (2003) and Syed-Ikhsan & Rowland (2004a) concluded that

there seems to be a lack of awareness of KM or clearly articulated KM strategies in

public organisations.

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An interesting finding with regards to using the City hospital Intranet for knowledge

sharing is the large size of the hospital. As is typical of most large organisations

where size can create unwieldiness and makes communication difficult, knowledge

sharing was revealed as varying considerably from within to across departments.

Within departments knowledge sharing was considered ‘free flowing’. The strength of

an interpersonal connection was found to affect how easily knowledge is shared

(Hansen, 1999). Previous research also found that employees who communicate with

each other frequently or who have a strong emotional attachment are more likely to

share knowledge than those who communicate infrequently or who are not

emotionally attached (Marouf, 2007).

However, knowledge sharing between departments was regarded sometimes as

‘patchy’ or ‘tribal’. It is acknowledged that organisational processes require the

involvement of two or more departments to be executed with each contributing its

own specialised knowledge. Nikula (1999) explains that the personnel structure and

the roles within healthcare are complex with a large number of professional groups.

Each group has roles, values and a sub-culture of its own. Hospitals reflect different

medical specialities with separate departments (for e.g. surgery, obstetrics and

oncology). Each department has its own management, budget and a separate website

on the hospital Intranet. Employees therefore often ‘mind the department’s own

business’.

The current shortages of nursing staff lead to the view by users in other departments

that the Nursing department wielded a lot of power and influence. There was a feeling

that the nurses received preferential treatment. Such a situation affected relationships

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between departments as highlighted by an interviewee. It could also promote silo

thinking or knowledge sharing occurring only within one department and not with

others (Riley, 2001). The resulting focus of organisational units on their specialised

capabilities (functions) thus created boundaries. These boundaries were often difficult

to penetrate and made inter-departmental knowledge sharing difficult or fragmented.

The interview findings showed that the City hospital Intranet enhanced organisational

awareness of each department’s role and how it was critical to the overall goals and

objectives of the hospital. The hospital Intranet was able to play a significant role in

softening or removing barriers of inter-departmental knowledge sharing between

departments. This was made possible by giving users access to the knowledge that

they would otherwise not have had about other departments. It provided access to

different functional knowledge bases. It also helped in reducing the informational

distance between users in different departments through increased communication and

collaboration using popular features such as E-mail. However, the findings also

revealed that the popular use of Intranet features such as E-mail, despite it benefits,

could also become overwhelming for employees. Users complained of spending

considerable time sifting through numerous emails daily which could be frustrating

and lead to a waste of their time. Users therefore needed to know how to efficiently

and effectively manage their E-mails for example, by properly prioritizing and

classifying them to ensure prompt retrieval.

The interview findings provided evidence that the City hospital Intranet played quite a

significant role in enabling knowledge sharing between departments. For example, it

enabled the publishing and sharing of meeting minutes and decisions of key

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committees and working groups. Users in different departments used E-mails and

discussion forums to communicate and collaborate at the hospital, increasing inter-

departmental awareness. Knowledge sharing using the Intranet helps to reduce the

barriers of status and power as well as informational and emotional distance between

the top, middle and lower strata in the hospital hierarchy. Users, regardless of their

rank/position in the hospital hierarchy, are able to use it to communicate and

collaborate easily. This is consistent with Sproull & Kiesler (1991) who claim that the

use of electronically-mediated communication such as E-mail is instrumental in

fostering ‘democracy’ in organisations.

The City hospital Intranet also enabled the sharing of best practices between

departments. The different departments/units of the hospital were able to identify

good practices, capture lessons learnt from the various projects and project outcomes

and use the Intranet as a means of sharing these good practices within the hospital.

The outcomes and lessons learnt of the various committees and projects were

published on the Intranet to support organisation-wide learning across the hospital and

guide similar projects or future committees. This helped to prevent the duplication of

work, reduce resource wastage and reduce the barriers between units. This again

enables a better appreciation of the role of each individual unit/department and how

they contribute to the overall hospital goals and objectives.

Quite importantly however, the findings of the interviews revealed a lack of

integration between the City hospital Intranet and what could be referred to as

‘human-based’ knowledge sharing mediums used at the hospital. For the purposes of

this research, human-based knowledge sharing mediums refer to ‘any knowledge

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sharing medium that does not make use of computer technology’. Previous research

has highlighted that a major factor impeding the effectiveness of IT tools for

knowledge sharing has been the ‘tacit’ nature of knowledge.

Various researchers contend that sharing tacit knowledge requires rich communication

mechanisms or human-based knowledge sharing mediums. For example, Zack (1993)

maintains that sharing tacit, contextual knowledge requires the use of highly

expressive and interactive communication modes such as face-to-face dialogue and

conversation when the individuals do not share an interpretive context. Davenport et

al. (1998) point out that personal contacts and interactions are very suitable for

transferring tacit knowledge. Swap et al. (2001) additionally suggest that tacit

knowledge requires the use of more personal interactions and training techniques.

This includes mentoring and story-telling which gives the knowledge shared its

needed context.

Davenport & Prusak (2000) also propose spontaneous unstructured face-to-face

meetings and the sharing of stories/narratives for effective knowledge sharing. Gold

& Holman (2001) reveal that storytelling provides a useful way of helping managers

articulate rich and detailed accounts of their work experiences. In turn they enable the

development of new understandings and insights. Looking at narratives as a form of

discourse, the authors suggest that narratives help to build a picture of complex social

situations and can promote sense making, reflection and development.

Joserrand (2004) argues that nurturing a climate in which knowledge sharing occurs

naturally requires self-organizing autonomous networks of people with similar

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interests or CoP’s/CoI’s. The CoP/CoI model is viewed as a means to overcoming

barriers to sharing information that technology-based KM systems often encounter

(Dixon, 2000).

Despite the time constraints faced in such a work environment by Intranet users, other

usually informal, human-based knowledge sharing mediums were popularly used and

considered essential at the City hospital. The human-based knowledge sharing

mediums identified within the City hospital can be categorized at three levels, the

individual, the group and organisational levels (see Table 8.1 below).

Level Mediums

Individual

Corridor/walkway chats, chats in the coffee lounge and

staff canteen, telephone calls, individual training

sessions and apprenticeships (e.g. senior doctors

comments to student or junior doctors).

Group

Formal and informal meetings, gatherings at hospital

events, inter-departmental meetings, hospital

committees, departmental seminars, informal networks

such as communities of practice/interest, mentoring

(e.g. ward grand rounds) and cross-functional

workshops.

Organisation

Hospital forums, hospital events, hospital newsletters,

hospital conferences/seminars, help-desk centres and

hospital journal publications.

Table 8.1: Human-based Knowledge Sharing Mediums at the City hospital

The results of the research clearly showed that other ‘people’ were identified as key

sources of knowledge. The tacit knowledge shared between colleagues formed an

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integral part of everyday work. This occurred due to the close daily interaction and

personal relationships that occur in such a highly dynamic and critical work

environment. However, they were not strategically integrated with the City hospital

Intranet, despite its various supporting features. Ward (2000) notes that just simply

acknowledging that mediums such coffee breaks, friendly cafeterias and casual

meetings play an important role in encouraging knowledge sharing is important.

According to Wolfe (2007), such informal interaction is critical in KM because of the

naturalness and the sheer amount of time people spend in this mode. It was common

to see employees participating in chats in the main corridor popularly referred to by

interviewees as ‘information walkways’ as a means of finding out the latest events in

the City hospital. Medical staff can be seen discussing critical issues regarding

patients. As previously mentioned in chapter 7, section 3.4.1, a medical doctor and a

resident clown were witnessed by this researcher discussing a child’s ailment in the

hospital corridor. An example of the knowledge sharing that was taking place

frequently in a social context. Earl (2001:227) poignantly suggests that the often

heard plea from users of arresting the tyranny of E-mail and wanting to start to ‘meet

and talk again’ is not just a complaint about E-mail overload. Rather, it is an

observation of how knowledge-rich channels can be subjugated and illegitimized by

technology solutions.

Lamont & Lesser (1999), examining KM in the public sector, found that informal

ways of transferring knowledge such as hallway conversations and team meetings

were not formally supported. Thus, impeding employee access to a key medium of

knowledge sharing. Brown et al. (2004) in addition, acknowledge that informal

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patterns of verbal information exchange occur innumerable times during the day as

care-givers ask questions of one another and make suggestions about plans of care. In

this context, healthcare professionals (i.e. nurses, respiratory therapists, nutritionists

and medical doctors) actively exchange knowledge while also allowing for a give and

take of ideas. Huysman & Wulf (2006) argue that ignoring the informal, non-

canonical nature of knowledge sharing, including people's motivation, ability and

opportunity to share knowledge is one of the key causes of resistance to the use of

knowledge-sharing tools.

Researchers (Ingirige et al., 2002; McDermott, 1999) have argued that IT alone

cannot be used as a tool to leverage shared knowledge in organisations. Alavi &

Leidner (2001) emphasize the importance of applying technology to increase ‘weak

ties’ (i.e. informal and casual contacts among individuals) in organisations. Firestone

(2003) points out that advanced IT tools such as the Intranet and its variations are able

to support knowledge sharing among members of a CoP/CoI. They do this by

providing access to common repositories and by creating collaborative spaces (e.g.

online discussion forums where knowledge can be exchanged).

As such, there is the important need as Reid et al. (2004) stated, to pay attention to the

subjective and sense-making roots of knowledge sharing. It is also important to pay

attention to the social context and the development of social relations to enhance

practical knowledge sharing. The application and integration of the Intranet with

existing human-based knowledge sharing mediums is of critical importance to better

facilitate the knowledge sharing process. For example, a CoP can achieve unique local

exchanges but the knowledge produced can be made available on the Intranet. Intranet

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features such as online discussion forums and common data repositories can also

facilitate efficient and effective knowledge sharing within the community.

An ongoing process of case discussions and outcomes by doctors for example can be

stored and shared on the hospital Intranet while at the same time supporting

continuous discussions. The Intranet is able to accelerate knowledge sharing

capabilities in both time and space dimensions (Mohamed et al., 2006). The hospital

Intranet can thus be able to facilitate and maintain organisational cohesion through

integrated knowledge sharing within the organisation, making boundaries more

permeable and increasing collaborative relations. What is not addressed in the extant

literature and in practice is the emphasis on the integration of tools such as the

Intranet with the popular human-based knowledge sharing mediums within

organisations.

Previous research (i.e. Davenport & Prusak, 1998) suggests that the presence of IT

will not make a person with expertise share it with others. While a valid point, it can

also be argued that the expert who does not want to share will not share regardless of

the medium. This was supported by the findings of the research which suggested that

knowledge sharing could be dependent on individual “personalities”. As Wolfe (2007)

contends, from a KM perspective, the overriding criterion for assessing an IT tool

should be whether or not the medium facilitates or hinders informal interaction and

hence, information and knowledge flows. A balanced, flexible approach integrating

the hospital Intranet with such human-based knowledge sharing mediums would thus

support the access, sharing and building of tacit knowledge. This in turn enables a

comprehensive framework for sustaining KM at the hospital.

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The interview findings with regards to the impact of the Intranet on knowledge

sharing represented by Nonaka & Takeuchi’s (1995) knowledge conversion model

showed the different roles and levels of impact that the City hospital Intranet had on

the four different modes of socialisation, externalisation, combination and

internalisation. The Intranet could be seen as a provider of ‘Ba’, or the place or

context providing the needed collaboration and interaction among individuals for

knowledge creation and sharing as described by Nonaka et al. (1999).

With regards to the process of socialisation, the interview findings revealed that the

City hospital Intranet was able to support various forms of personal interaction

through E-mail, discussion forums, employee work schedule calendars and the staff

paging system for instant messaging. These features allowed for one-to-one, one-to-

many and many-to-many interactions. Thereby linking knowledgeable individuals

with each other. The socialisation process is thus facilitated electronically in a rich

way. Previous research by Ngwenyama & Lee (2002) demonstrated that a ‘lean’

communication medium such as E-mail has a rich capacity for exchanging tacit

thoughts. An example is the evolution of the ‘smiley ’ in E-mails that allows the

expressions of feelings in communication. E-mails can however become quickly

overwhelming as shown in this research hence, some form of filtering or

customization process is required for managing E-mails. From these research findings

it can be concluded that the Intranet can support socialisation, especially in a large

pubic healthcare hospital with non-collocated and time-constrained employees.

The interview findings showed that the City hospital Intranet was able to facilitate the

externalisation process in knowledge sharing at the hospital by assimilating and

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integrating knowledge from various parts of the hospital. The Intranet provided access

to among other things, a rich multi-format source of hospital policies and procedures,

clinical and patient records, employee information, forms, as well as educational and

training material. Its ‘quick links’ feature provides users with easy access to the

various committees, groups, project outcomes in the form of best practice and

completion reports. These organisational knowledge bases available on the hospital

Intranet could be modified, integrated and searched.

Previous research by Damsgaard & Scheepers (2001) provides supporting evidence,

pointing out that needed information can be ‘recorded’ in the various reports, meeting

minutes and manuals. This information could then be assimilated and integrated into

the organisational memory (Huber, 1991). This recorded information can be shared

among users through a rich and diverse media via the Intranet, making employees

better informed. The popular usage of E-mail to enable the externalisation process is

supported by Bontis et al. (2003) who discussed that E-mail usage helped to convert

redundant information into explicit knowledge. However, the poor search

functionality would pose a barrier to the effective and prompt extraction of the needed

information.

A key issue identified in this research therefore is the critical importance of the

‘search’ functionality of IT tools used for KM. The ineffective ‘search’ function of the

City hospital Intranet clearly affected the ability of the users to create and share

knowledge from the extensive organisational-wide knowledge bases available.

Various researchers (Geisler & Rubenstein, 2003; Barnum & Dragga., 2002; Nielsen,

2002; Grimstead, 2001) have stressed the need for adequate Intranet search

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functionalities that can deliver requested information promptly. Especially in a critical

work environment where lives might be at stake, poor search functionality affects

rightly-informed, decisive and timely decisions. This would subsequently lead to the

reduced usage of the Intranet (Geisler & Rubenstein, 2003; Nielsen, 2002).

The interview findings also revealed that the City hospital Intranet enables the

capturing and integration of new explicit knowledge, thus facilitating the combination

process of knowledge sharing. The Intranet enabled the merging, reclassifying and

synthesizing of existing explicit knowledge available in the various hospital reports,

manuals, policies and procedures. This allowed users to create and share new

documents with added value from explicit knowledge integrated from existing

documents.

Damsgaard & Scheepers (2001) additionally explain that the hypertext structure

linking documents and websites on an Intranet helps this process because the

navigation through links can create a new organisation of concepts as well as the

explicit knowledge that exists. However, due to the poor ‘search’ functionality of the

hospital Intranet, needed knowledge may not be accurately and efficiently retrieved.

Therefore, users need to be able to efficiently and effectively identify and retrieve the

information they require. A simple ‘search’ function is not sufficient and the lack of

advanced search features on the hospital Intranet adversely affected the user’s usage

and ability to create and share new knowledge from the combination of the existing

explicit knowledge available.

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The interview findings also showed that the advanced features of the City hospital

Intranet could support the knowledge sharing process of internalisation. For example,

the hospital Intranet’s online training and simulation programs enabled users to

identify new knowledge. This was possible through the imbibing of new concepts

which were embodied in the various learning-by-doing functions available as part of

these programs. As Becerra-Fernandez & Sabherwal (2001) explain, the

internalisation process is appropriate for a focused-task domain. These online training

and simulation features also enabled access, regardless of time or place. They also

provided convenience for users in an exceptionally dynamic and time-constrained

work environment. It is important to point out that most of the online training and

simulation programs were mandatory job requirements for employees. However, it

was obvious that the availability alone of these programs was not sufficient enough to

turn an uninterested individual into an active user.

Damsgaard & Scheepers (2001) in support explain that firstly, such simulation

programs help users to understand the organisation and their roles. Secondly, there is

a process of embodying the explicit knowledge by using simulations or experiments

to trigger learning-by-doing processes. New concepts or methods can thus be learned

in virtual situations. Using the Intranet browser as a standard front-end, the Intranet

enables users to gain direct access to systems and repositories of information located

in other parts of the City hospital.

This research is able to show that while knowledge sharing remains largely an act of

employees or ‘humans’ in the City hospital, IT tools such as the Intranet, because of

its various advanced features and functional adaptability can facilitate the knowledge

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sharing processes of socialisation, externalisation, combination and

internationalisation. There were however technical problems associated with the

usage of the hospital Intranet in this regard. The poor search functionality in particular

was revealed as a common limiting factor.



within the hospital?

Addressing the issues of the key issues faced by users, the findings of the research

revealed several barriers impeding the usage of the City hospital Intranet for

knowledge sharing (see Table 8.2 below for a summary of technical and non-technical

barriers).

Type of Barrier Factors

Technical

Poor search functionality, inability to personalise

individual Intranet websites and rigid layout structure.

Non-Technical

Lack of time, the lack of clearly-defined KM strategy,

inadequate user training, lack of user awareness of

Intranet benefits for KM, inadequate staffing and high

staff turnover, influence of political policies and

professional resistance.

Table 8.2 Summary of the Technical and Non-Technical Barriers Affecting the Usage of the City

Hospital Intranet for Knowledge Sharing

The findings of the questionnaire and interview-based studies revealed indicated that

the most common technical barrier faced by users of the hospital Intranet for

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knowledge sharing was the poor ‘search’ functionality. This can be especially critical

as the work context is one that is characterised in most cases by the need for rightly-

informed, decisive and timely decisions. Poor ‘search’ functionality however means a

loss of trust becomes built into the experience of the Intranet. Geisler & Rubenstein

(2003) count search functions that do not deliver the requested information among the

factors that affect usage of an IT tool for supporting KM.

Mansell-Lewis (1997) poignantly points out that Intranets are only as good as their

content. In addition, an essential tenet of effective communication requires the content

to be accessible in order to be valuable (Grimstead, 2001, Barnum & Dragga, 2002).

Nielsen (2002) also remarks that ‘poor search’ functionality was the greatest single

cause of reduced usability of Intranets. Once a user had realised that the information

accessed was hard to find, there was reluctance to use the Intranet again. Intranet

content therefore needs to be quick and easy to find to ensure its continued usefulness.

It is also important to trace items back to their earliest manifestation, thereby allowing

employees access to prior knowledge’. In this sense, according to Yakhlef (2005),

employees become better able to learn from similar completed projects and

experiences. This reduces the need to ‘re-invent the wheel’ when similar problems are

faced. Sarnoff & Wimmer (2003) believe a successful Intranet is built on the premise

of avoiding the frustrations of ‘information overload’ wherever possible through

among other things, an effective search engine. A poor ‘search’ engine means that

while the quantity of information continues to grow exponentially at the City hospital

with time, the level of usage would most likely fall.

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Linked to the poor search functionality was the view by users that the information

provided on the City hospital Intranet was overwhelming and sometimes outdated.

Grammer (2000) referred to this as ‘infoglut’ or when the amount of information

Intranets make available to users can quickly become overwhelming. Sarnoff &

Wimmer (2003) speak of an Intranet content-management approach that values

quality over quantity. As Espinosa (1998) highlights, poor quality data can have a

detrimental impact on the perception of health data availability and on its usefulness

for clinicians and policy makers. Data that are of poor quality, in an antiquated state,

or of low relevance will increase uncertainty in information generated and decrease

the reliability of decisions made from the system. The standards agreed to were

therefore more than justified.

At the City hospital however, ambiguity was prevalent. On the one hand there was the

complaint about out-dated information by users, on the other hand most interviewees

admitted that it was every individual department’s responsibility to keep the

information on their sites up-to-date mostly through their IT contacts or document

authors. Nevertheless, this was not always the case. It would seem that IT contacts

gave priority to their primary job responsibilities which was performed in addition to

the function of being an IT contact. The dynamic nature of work and the speed with

which needed information changes (for e.g. in policies and procedures) creates an

important need for accurate information. A poor search would therefore mean that as

the quantity of information continued to grow exponentially on the hospital Intranet,

so would overwhelming, outdated and irrelevant information.

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Another key technical barrier reported by interviewees was the inability to personalise

individual views of the City hospital Intranet. As previously highlighted, information

provided on an Intranet can sometimes be overwhelming. Making the Intranet

completely unwieldy, presenting a highly fragmented and confusing user experience,

with no consistency and little navigational support. Advanced Intranets have come to

include portal functionality. This portal functionality provides an effective means of

controlling and filtering information by offering a customisable user interface (Aneja

et al., 2000). It allows users to interactively modify their interfaces and specify their

own preferences to fit individual preferences, job functions or roles (Pangaro, 1999).

It is also able to use such information to dynamically deliver specified content to

users. Users are able to personalise main pages of the Intranet and modify the sources

of information, the style of presentation and interface layout with a single-point of

access to only mission-critical applications, specific data sources and any other

needed knowledge to suit the individual or group user requirements.

A lack of personalisation can therefore result in the under-utilisation of Intranets and

even more silos of information added to knowledge base (Newell et al., 2003).

Stenmark (2003) in support also suggests that Intranets have been subjected to the

standardisation and control urge that shaped organisations of the industrial age. It can

thus be argued that there is a need for flexibility that helps improve the feelings that

employees associate with the hospital Intranet. Intranet usage should be related to a

more open and flexible approach, rather than a bureaucratic one of more controls and

procedures.

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The argument however could conversely be made that giving users the ability to

determine what knowledge they require can again reinforce existing functional

barriers in an organisation as discussed by Newell et al. (2003). Users would only

have a limited view of the organisation and this could thus adversely affect

organisational integration. Others such as Duane & Finnegan (2003) have advocated a

balance between central control, user empowerment and ownership. It could possibly

be suggested that those responsible for administering Intranets need to be proactive in

determining how stakeholders actually use knowledge in their work. The management

of the context of the Intranet is therefore crucial. The process of standardizing and

formalising Intranet content and usage may be the best choice in a work context

characterised by stability, predictability and recurring events. In contrast, in an

environment of rapid change, uncertainty and new challenges, more ownership and

flexibility should be accorded to the users. Whilst at the same time, a unified view of

the available hospital knowledge needs to be ensured.

The results of the interviews also showed that many interviewees felt that because the

hospital Intranet had a standardized layout and content presentation, it restricted what

information could be presented. On the one hand, each occupational group (e.g.

medical doctors, nurses and administrators) may have particular needs. These needs

affect the type of access and the format in which knowledge sharing occurs, thus

requiring flexibility in the layout structure. A lack of flexibility could impede usage

and lead to Intranet users setting up their own ‘rebel’ sites where they can provide

access and share needed knowledge. On the other hand, the lack of a standardized

layout structure might restrict the unified view of the organisation that the Intranet

seeks to portray. A flexible structure might also render generic information (e.g. the

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simple location of staff contact details on a departmental website) hard to find. A

framework that keeps the layout of certain information structured while providing

flexibility for the presentation of department specific information might be suggested.

Ammenwerth et al. (2003) agree and recommend that while the IT tool may be similar

in various departments, the processes, users, functionality and in this case content may

differ.

The non-technical barriers identified in the usage of the Intranet could be categorised

as behavioural, educational and managerial barriers. With regards to behavioural

barriers, interviewees viewed time constraints as the most prominent barrier impeding

the usage of the Intranet for knowledge sharing. Interviewees felt that they were

already pressed for time with their job roles. This finding is consistent with previous

research findings where the most common and often the first barrier to be expressed,

especially by medical doctors, in the usage of computerised systems in a medical

context was the lack of time (Short et al., 2004; Dawes & Uchechukwu, 2003;

Metcalfe et al., 2001; Closs & Lewin, 1998; Berg et al., 1998; Sullivan & Mitchell,

1995). Given the importance of time and the wide variation in knowledge seeking

behaviour, users are even less likely to use a system where accessing information

involves a complex or time consuming process (Short et al., 2004).

In this particular work environment, emerging problems have to be managed within

the City hospital’s working routines. It has been recognized for example, that medical

doctors have to prioritize a plethora of potential tasks and divergent information into a

clear notion of ‘what to do next’ (Berg, 1996). Tarala & Vickery (2005) investigating

the non-attendance of medical doctors at medical education activities identified a

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number of reasons that are equally applicable at the City hospital and could have

contributed to busier schedules, some of which include:

Increased clinical and administrative loads;

Managerial pressure and the requirement for clinicians to be increasingly

accountable for their actions-the perceived difficulty of justifying non-patient

contact time and;

Increased numbers of specialised meetings, rather than whole-of-hospital or

undifferentiated cross-disciplinary meetings.

The interview findings revealed that it was a question of assigned priority, the need as

pointed out to ‘make’ time. It is important as suggested by Oliver & Kandadi (2006)

therefore, that senior and middle management convey this importance by continuously

reinforcing the significance and value of using the Intranet for knowledge sharing.

The interview findings showed that another behavioural barrier impeding the usage of

the hospital Intranet for knowledge sharing was professional resistance and scepticism

among health practitioners, particularly towards Intranet use. Conte (1999:12) notes

that: “lacking training and basic familiarity with information tools, many physicians

have a common reaction to the so-called information revolution and are

overwhelmed”. Goldsmith (2000) further explains that the greatest barrier to realizing

the full potential of computing technologies in the healthcare environment is

persuading medical doctors to use these technologies. Historically, the physician has

been the principal integrator of knowledge in healthcare. Chau & Hu (2002) argue

that medical doctors play a fundamental role in the adoption and use of IT. Due to the

centralisation of knowledge not easily relinquished or shared within the profession,

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there could be a fear of losing status and power (Van Beveren, 2003), thus having an

effect on professional egos.

For older health professionals in particular, not being familiar with the Intranet could

lead to a sense of scepticism and resistance towards the usage of the Intranet for

knowledge sharing. The research results show a strong preference for ‘collegial’ talk

among health practitioners who prefer to discuss issues face-to-face. Hence, senior

management should try and reassure what Goldsmith (2000:150) refers to as:

“sceptical, time-famished healthcare practitioners” that the Intranet actually can

complement face-to-face conversations. There is a need to make users aware of the

benefits of using the hospital Intranet for knowledge sharing, especially with regards

their job roles/functions. The usage of the Intranet to facilitate and/or supplement

collegial knowledge sharing pointed out earlier, would also help to encourage

acceptance and increased Intranet usage.

Difficulties impeding the usage of the Intranet for knowledge sharing and categorised

as educational barriers included the lack of training in the usage of the City hospital

Intranet. This was also highlighted in the results from the questionnaire-based study.

These findings were however inconsistent with the fact that training programs were

available and were conducted regularly. While interviewees were aware that training

sessions were regularly provided, many again admitted that the previously mentioned

time constraints prevented their participation.

Many researchers have stressed the importance of training for technology usage in

general (Davenport & Prusak, 2000; Earl, 1998; Igbaria, et al., 1997; Scott, 1998).

Earl (1998) argues that if knowledge is to be used as a basis of strategy, then

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providing users with training on how to use the technology is essential. The

development and usage of an Intranet in an organisation allows employees to become

content providers and managers. This means they require adequate training in

publishing tools, security and confidentiality procedures, archiving, document

management and design. Particularly if the full potentials of the Intranet are to be

realised in the organisation. The opportunity for training is one of the key aspects

contributing to the end-user’s satisfaction (Costa et al., 2004). Comprehensive IT

training for Intranet users therefore ensures maximum benefits to health professionals

and consequently to the patients.

Without proper training, users are likely to experience problems and to struggle in

using the system (Igbaria et al., 1997). Researchers (see for e.g. Caputi et al., 1995;

Jayasuriya, 1998) have also identified positive computer attitudes of healthcare

professionals as being positively associated with their degree of training and computer

experience. The lack of adequate training on proper Intranet usage would have an

impact on the skill level needed by employees at the City hospital to effectively use it.

Interestingly, the interview findings suggest that the provision of training alone is not

a sufficient remedy as the lack of training is linked to time constraints. Cong &

Pandya (2003) stress the need for organisations to make training a key component of

any KM initiative. Their findings also suggest a need for senior and middle-

management endorsement of the training programs and the allocation of time for the

training sessions available, so that users are able to fully realise the potential and

benefits of the hospital Intranet.

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In what could also be linked to a lack of training, the interviews showed that another

educational barrier impeding the usage of the City hospital Intranet for knowledge

sharing was a lack of awareness of its benefits and potentials. The goals and

objectives of the Intranet were not clearly articulated and communicated to the users.

While some of the employees are familiar with KM in general and are involved in

various KM activities, there is inadequate awareness of the benefits that the Intranet

offers in strategically supporting knowledge sharing in particular. This could be

linked to the lack of a clearly defined KM strategy, adequate training and education.

Previous findings by Cong & Pandya (2003) indicate that such lack of awareness

exists in public organisations. The awareness of Intranet benefits for knowledge

sharing would mean a stronger impetus for using the Intranet to exchange ideas and

thus enhance productivity. Without awareness of the potential benefits there can be no

grassroots support for the usage of the Intranet for knowledge sharing within an

organisation.

Among the barriers revealed from the interview findings and classified as managerial

barriers included the lack of a specific, clearly defined KM strategy. This meant that

Intranet usage for knowledge sharing at the City hospital was not efficiently

coordinated and guided. Alavi & Leidner (2001) view a KM strategy as referring to an

organisation's systematic effort to manage their organisational knowledge. Although a

KM framework was developed by the IT department, it was subsumed within the

overall IT strategy at the City hospital. While this strategy governed the hospital

Intranet, the interview results revealed that users were generally unaware of KM goals

and objectives. Additionally, the formulation and implementation of the IT strategy

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was naturally placed under the control of the IT department. This effectively made the

IT department in charge of KM initiatives at the hospital.

Uit Beijerse (2000) states that the lack of a clearly defined KM strategy is one of the

factors that can impede KM. According to Zack (1999b), a KM strategy helps to

reduce the identified internal strategic knowledge gaps or the difference between what

the organisation ‘must’ know and what it ‘does’ know. A KM strategy ensures that

appropriate KM initiatives are developed in order to reduce these gaps. Keskin (2005)

stresses the importance of making the strategy explicit. Previous research also points

out that only a small proportion of public sector organisations have formal KM

strategies or programs in place (Skyrme, 2003).

Van Beveren (2003) goes on to explain that the professions that combine to offer

healthcare services have their own set of values and directions often stated in a code

of ethics. Government policy and legislation also offers direction and guidelines for

those practicing professionals. The combination of all these sources offer a set of

goals and strategic directions clearly understood and conveyed to all who provide

healthcare delivery. Such common vision and a common set of goals are required to

direct the users sharing and application of knowledge. Management must

communicate a clear and consistent message about the corporate vision, strategy,

goals and objectives. A common vision establishes a purpose for employees to co-

operate and share knowledge. Therefore, although the IT department at the City

hospital was supportive, involved users in its management, provided training and

sought feedback. The lack of a central vision meant users were not able to see the ‘big

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picture’ in terms of how usage of the hospital Intranet aided in the achievement of

KM goals and objectives.

The way in which KM is implemented in an organisation depends upon the

organisations objectives and environment (Housel et al., 2001). The KM strategy

however, sets out the goals, objectives and the direction of the organisation with

regards to KM and how they are to be supported by employees and support systems

such as the Intranet. In addition to dedicating the needed amount of human and

material resources, a clearly defined KM strategy would assist in ensuring that KM

initiatives in the hospital are made apparent to employees and would also be

instrumental in guaranteeing their success.

Inadequate staffing and a high staff turnover were indicated by the interview findings

as managerial barriers that affect the usage of the City hospital Intranet for knowledge

sharing. The lack of assigned staff with clearly defined roles and responsibilities in

terms of KM within individual departments/units was regularly reiterated by

interviewees as an issue that affected effective Intranet usage. Consequently, KM

initiatives were not properly developed, coordinated and monitored to ensure

effectiveness, especially with regards the usage of the Intranet. While this seems to be

a dilemma in many organisations, McAdam & Reid (2000) concluded that in most of

the organisations there was a lack of assigned responsibility in terms of KM

processes.

The prevalent condition of chronic staff shortages in the Australian public healthcare

sector would have contributed to this situation at the City hospital. Nikula (1999)

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states that less employees are available to perform the same amount of work as before

in the healthcare sector, while the need for healthcare service delivery increases.

Bakker (2002) in support reveals that unlike organisations in the private sector such as

banking where staff can make way for IT tools in certain tasks, in healthcare the

primary process is caring for people. While this may be supported by IT, IT can

seldom replace human activity. In addition, the lack of a clearly defined KM strategy

means staff needs and requirements are not properly planned for. According to

Robertson (2004), staffing needs must be incorporated into KM initiatives within the

organisation. While IT contacts were designated in individual departments, their busy

primary roles within their departments appear to make it difficult for them to

appropriately carry out their duties as IT contacts. Without designated and dedicated

staff, KM programs involving the Intranet cannot be properly identified, developed,

coordinated and monitored.

With the need to make do with limited staff availability, there is the important need to

for senior and middle management to support such IT contact roles. It is important to

select suitable people within each unit/department to identify and coordinate

knowledge activities while encouraging the usage of the Intranet to facilitate them.

The support by senior and middle management will show commitment as well as

access to the necessary resources needed. They would also need to be suitably

supported by other key departments such as HR who can share insight on incentives,

training and other employee related issues. While it is obvious that this would require

the dedication of a significant amount of resources, it helps in ensuring that KM

efforts in the organisation are made apparent to employees to guarantee success.

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Finally, the impact of political policies was revealed as a barrier by users impeding

the usage of the City hospital Intranet for knowledge sharing. This was due to the

prevailing situation of uncertainty being experienced at the hospital. Previous research

(e.g. Lenk et al., 2002) points out that one of the key characteristics of public sector

organisations is the high influence of the political sector over the way public

organisations operate. Cong & Pandya (2003) see this particular framework existing

because public organisations are usually ‘stakeholder’ dependant. The stakeholder

approach involves multiple parties in the process, such as the Government and it is

complex to deal with. A public organisation must therefore abide by a wide range of

legislative and political directives and changes in the interest of the stakeholders (Van

Beveren, 2003).

This close relationship with political factors and recurrent policy changes can

adversely affect KM processes (Syed-Ikhsan & Rowland, 2004). Additionally, Van

Beveren (2003) found that Government policy has a direct impact on the direction and

focus for organisational outcomes. The change in Government policy causes

confusion and disruption that often leads to a lag in the implementation of strategy to

meet the new directions. This situation creates an environment of uncertainty among

employees. It could affect the usage of IT tools that are an integral part of daily work,

in this case the City hospital Intranet for knowledge sharing. The lack of

implementation of a rumoured policy over a significant period of time here would

affect the introduction and implementation of clearly defined strategies, needed

upgrades and proper administration of the City hospital’s Intranet. This consequently

affects employee behaviour in terms of Intranet usage for knowledge sharing.

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Previous research by Lorenzi & Riley (2003) pointed to the lack of focus on

organisational conditions such as culture and structure as an important reason why IT

usage fails in organisations. There are therefore some fundamental conditions that

have to be in place. These conditions will at all times either be acting as enablers of,

or barriers to effective KM (Cong & Pandya, 2003; Bansal, 2001). Interviewee

responses to the key enabling conditions of a knowledge sharing culture and the

decentralised structure governing the usage of the Intranet as reported by the literature

were investigated.

As previously discussed in chapter three, section 3.6.2 of the literature review, a

culture that is conducive to knowledge sharing in the organisation is a key factor for

IT tools such as the Intranet to effectively and efficiently facilitate knowledge sharing

(Stenmark, 2003; Bansal, 2001; Damsgaard & Scheepers, 2001; Carvalho & Ferreira,

2001; Hislop, 2001; Choo et al., 2000; DeLong & Fahey, 2000; Jarvenpaa & Staples,

2000; Davenport et al., 1998; Ruggles, 1998; Telleen, 1997). The factors developed

by Lee & Choi (2003) measuring how conducive organisational culture was to

knowledge sharing were adopted and investigated. These factors included: the value

of knowledge sharing and the willingness to share; organisational promotion and

support for knowledge sharing; rewards for knowledge sharing and departmental and

organisational cohesiveness (viewing of department and hospital as one team).

The findings of the interviews revealed that there was a general value and willingness

to share among Intranet users. However, this varied based on the personalities of the

employees involved. According to Nohria (2000), organizations are knit together by

ties of a complex and diverse nature. Ties can differ according to whether they are

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based on friendship, work, or advice; and whether what flows through them are

resources, information, knowledge or affection. Geisler & Rubenstein (2003)

emphasize employee understanding of the positive effects of a knowledge sharing

culture as critical. The findings showed that this was clearly evident at the City

hospital. This was also due to the educational environment fostered by the City

hospital being a teaching hospital (as highlighted in chapter five, section 5.1). Senior

Management was found to provide support for knowledge sharing at the City hospital

by publicly encouraging it. Previous research by Guenther & Braun (2001) also stress

the importance of senior management participation as support is crucial to the

successful usage of the Intranet for KM. Furthermore, Berg (2001) also explains that

the success of an IT system in a hospital in particular is decided by the interaction

between the work floor, middle management and senior managers.

At the City hospital, rewards for knowledge sharing were not provided. Users

overwhelmingly agreed that they did not have any preference, particularly for

financial rewards. However, they stressed that acknowledgements should be given to

those who were proactive in using the Intranet for knowledge sharing. Milne (2007),

citing Khojasteh's (1993) study of what constituted greater motivating potential for

private than public sector managers, found that the intrinsic reward factor of

recognition was ranked a very important motivating factor in the public sector in

contrast to the private sector. This lack of interest in financial incentives could also be

due to knowledge sharing at the hospital being viewed as an expectation employees

have of each other, a sentiment echoed by most interviewees. Possible reasons also

stem from the unified feelings and altruistic nature of employees as a result of their

focus on common goals.

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Additionally, previous research (e.g. OECD & PUMA survey report, 2003) points out

that incentives in public organisations encourage an atmosphere of cooperation

between the employees that is not provided in the same way as it is in private

organisations. The findings of this research provide evidence that suggest employees

would prefer to see rewards that recognize competence or a high level of participation

as this would motivate similar responses. This also supports the findings by some

researchers (e.g. Robinson & Stern, 1998; Stenmark, 2000) who argue that when

people are primarily motivated by their own interest and enjoyment in their work,

they are more likely to participate in that activity than if they were primarily driven by

goals imposed by others. The use of extrinsic rewards or bonuses, Stenmark (2000)

further elaborates, tends to shift a focus on the reward itself rather than the task at

hand. Management would thus need to publicly acknowledge the contributions of

employees towards the usage of the Intranet for knowledge sharing.

The interview findings on the last factor investigating the conduciveness of the culture

to knowledge sharing showed that interviewees regarded their departments as one

team. This though could not be said for the whole organisation. In such a large

organisation, various subcultures would be abound. This is how members in these

sub-units form a sense of identity. Clegg et al. (2006) explain that culture is a plural

word, not uniform, yet flourishing under conditions that are highly variable for their

patterning and formation. Nonetheless, by virtue of being a children’s hospital, the

feeling of unity or ‘homogeneity’ was strengthened by the strong attachment of

employees to the vision and mission of the hospital. This strong bond was also

evident as explained by interviewees when faced with external circumstances such as

quality evaluations.

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It could thus be concluded that the organisational culture at the City hospital could

overall be viewed as being conducive to knowledge sharing. The findings showed that

it was a critical organisational factor that users felt needed to be in place for the

effective usage of the Intranet. Based on the issues investigated, the findings also

highlighted the importance of the behavioural factors such as employee personalities.

It also exposed the critical importance of senior and middle management support and

rewards in the form of acknowledgements. The findings also reflected views that

organisational cohesiveness although present, could vary, but was enhanced by the

prevailing culture of the hospital. Overall, the findings provide supporting evidence to

previous research studies that have stressed the need for an organisational culture that

promotes knowledge sharing and one of the most important factors for the successful

usage of IT for KM, particularly the process of knowledge sharing.

It has been suggested in the literature (as stated in chapter 3, section 3.6.3) that a

decentralised structure governing IT is a key enabling condition for effective usage.

Previous research suggests that the structure governing an IT tool affects employee

interaction, communication and collaboration. It is clearly critical as Hinrichs (1997)

emphasizes, that the ability to manage the Intranet effectively is one of the most

significant constrains to its further development. Curry & Stancich (2000:250)

similarly argue that Intranets must be “well managed and planned, not allowed to

evolve merely in an ad hoc manner, which can too often be the case”. It can also be

argued that the larger an organisation is, the more complex its structure will be. The

larger or more complex the structure is, the harder it could be to share knowledge

within the organisation. This would possibly be accentuated in a public sector

organisation that usually has a traditionally bureaucratic and hierarchical structure.

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This type of structure, common in public organisations, provides for rigid control and

coordination. A recurrent view advocated in the literature suggests that Intranet rules,

procedures, routines and content especially in large organisations must be strictly

managed, standardised and formalised. In other words, they must be centralised to

avoid chaos and the failure of the Intranet.

The interview findings on the structure governing the City hospital Intranet showed

differing opinions on the existing structure as well its level of significance as a key

enabling condition. A further review of the literature reveals differing opinions as to

the type of structure that should govern IT usage. They also show support for the two

distinct approaches of centralisation and decentralisation as the approach that best

suits the management of the Intranet. Stenmark (2003) points out that the Intranet has

been subjected to the standardisation and ‘urge to control’ that shaped organisations

of the industrial age. This mechanistic approach with its need for control and

measurement affords organisations the comforts of stability and order that have been

advocated by the management literature at large. Stenmark (2003) therefore feels that

Intranets have to break with the mechanistic control paradigm that plagued traditional

IT tools and they should have a decentralised structure.

According to Van Beveren (2003) however, a structured approach governing the

Intranet might be deemed necessary given the legal, ethical and moral obligations

encompassing the provision of healthcare. Other researchers (e.g. Damsgaard &

Scheepers, 2000; Lamb & Davidson, 2000) argue that the Intranet content must be

controlled via standardisation and formalisation with the role of monitoring and

control resting in the hands of the IT department. The IT department could manage

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and control some aspects of the Intranet more effectively than other personnel. For

example, ensuring the security and integrity of data and networks. Taking into

consideration the needs of the whole organisation, IT departments are keen to impose

‘order’, secure corporate data, monitor network traffic, set limits to Intranet usage,

ensure documentation and continuity of user-developed Intranet sites, reduce

duplications of effort and so on (Sliva, 1999). However, as Lamb & Davidson (2000)

point out, in the Intranet era, ‘end users’ cannot be treated by IT professionals as low-

level, computer-fearful, data-entry staffers who do not know what they need in

computerised applications. Instead, many are technologically sophisticated and have

superior knowledge of the content needed in Intranet applications.

It would therefore appear that both structural approaches have their inherent

advantages and disadvantages. A centralised organisational structure governing the

Intranet ensures consistency throughout the organisation but limits creativity and

restricts ownership for the units/departments represented. A decentralised structure on

the other hand, where departments are allowed to create and operate their own

websites or their own servers would create a sense of ownership and foster creativity.

However, the lack of centralised control leads to problems concerning the

standardisation of layout and inconsistencies in content quality. This could make

information harder to find and increase the risk of information overload (Desanctis &

Monge, 1999).

The lack of a standardized layout structure could in turn restrict the unified view of

the organisation that the Intranet seeks to portray. A flexible structure might also

make generic information (e.g. the simple location of staff contact details on a

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departmental website) hard to find. The research findings provide evidence that each

stakeholder group (e.g. medical doctors, nurses and administrators) have individual

needs. These needs include the provision of access to and sharing of knowledge in

particular formats, thus requiring flexibility in the layout structure.

An alternative approach however would be to take into consideration the type and

nature of the organisation (e.g. private or public, large or small) and the needs of the

users. The findings provide a strong indication that the adoption of a strict centralised

or decentralised approach need not be adopted to facilitate usage of the Intranet for

knowledge sharing. In an organisation such as a hospital that may at times be

comprised of semi-autonomous bodies, strict standardisation could adversely affect

the usage of the Intranet.

The governing structure of the City hospital Intranet is of a ‘hybrid’ nature or a

combination of both centralised and decentralised elements. While centrally

controlled and monitored, individual departments and divisions can implement

changes within a set framework and standardized Intranet layout. The structure

governing the Intranet was therefore centralised with decentralised publishing

procedures which was key to its usage. The hybrid structure is able to ensure

adequate security, maintain standardisation of the layout and content quality. It also

allows users to take a more active role in the development and control of their

individual Intranet sites through available customisation and personalisation features.

The findings suggest the need for a framework that keeps the layout of certain

information structured, while providing flexibility for the presentation of department

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specific information. This can be referred to as a kind of ‘controlled chaos’ and would

be suitable as a structural approach for governing Intranets, especially in such a

dynamic public sector organisation where users have different knowledge needs and

requirements. For example, at the hospital there was no need for a formal process of

approval when changing content as certain people in each department were referred to

and designated as IT contacts. They were able to update or edit information on their

own department websites without having to go through the IT department. A need for

a centralised structure governing the Intranet is also evidenced by some of the

impeding factors already highlighted, including a lack of time, lack of training as well

as a high level of staff turnover.

An overview of the key research findings is presented in figure 8.1 below.

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_

+

ENABLERS

USAGE OF THE INTRANET FOR KNOWLEDGE

SHARING

Socialization

Externalisation

Combination

Internalisation

TECHNICAL BARRIERS NON-TECHNICAL BARRIERS

Technical Success Factors

Intranet scalability. Accessability and

usability.

Non-Technical Success Factors

Supportive IT department. IT Contacts.

Structure

Hybrid of centralized and decentralized

structure.

Culture Value & willingness

to share. Senior management

support. Reward for

knowledge sharing. Viewing department and organisation as

one team.

Behavioural Barriers

Lack of time. Professional

resistance and scepticism.

Educational Barriers

Lack of user

awareness of KM benefits.

Inadequate user training.

Managerial Barriers

Lack of a clearly

defined KM strategy.

Inadequate staffing and High staff

turnover. Influence of

political policies.

Search functionality.

Inability to personalise

individual Intranet websites.

Rigid layout structure.

Fig 8.1 Overview of Key Research Findings

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8.2 Research Contributions

The findings of the research provide a number of key contributions. A review of the

literature revealed a lack of studies investigating KM and the usage of IT tools for

facilitating KM in the public sector and in public hospitals in particular. Previous

studies investigating the implementation and usage of IT tools that support KM such

as Intranets have primarily focused on private sector organisations. There was

therefore a pertinent need to investigate the usage of such modern IT tools in a public

sector hospital that could take into consideration the intricacies and unique

environment of such an organisation.

From a theoretical perspective, in comparison to other areas of organisational

research, the research into KM systems and tools in organisations is still in its infancy

(Gallupe, 2001). Previous research has drawn specific attention to the lack of research

conducted on the usage of IT for facilitating KM and have called for more studies (see

Alavi, 2000; Gottschalk, 2000; Borell et al., 2001; Stoddart, 2001; Gallupe, 2001;

Alavi & Leidner, 2001). Many have suggested that the present literature on KM and

KM systems fails to address the role of IT systems in, among other things, the

creation, sharing and usage of knowledge in organisations (Galliers, 1999). This

research is a response to that call, adding to the body of knowledge on IT tools for

supporting KM. It provides a critical insight and understanding of the usage, impact

and influencing factors surrounding the usage of the Intranet for supporting the

knowledge sharing process in a large public sector hospital.

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This research contributes to the limited studies investigating KM in public sector

organisations, adding to the work of researchers such as Reige & Lindsay (2006),

Syed-Ikhsan & Rowland (2004) and Cong & Pandya (2003). This research also adds

to the even smaller body of knowledge on IT tools that support KM in the public

health sector. It is a response to the call of Haux (2006) for research into IT tools in

the healthcare sector. This is of particular significance in Australia where it has been

shown that healthcare organisations have been slow to adopt IT. The research was

therefore able to contribute to the understanding of the current nature of Intranet usage

and issues faced at an Australian public hospital. It showed that the Intranet plays a

pivotal and positive role in facilitating knowledge sharing in an organisation where

life and death issues are a part of the work environment.

The results of this research add to the importance of getting users involved in the

development, implementation and continuous feedback/consultation regarding the

Intranet. The findings suggest that KM approaches involving IT tools in the healthcare

sector must take into consideration the unique nature of organisations such as large

public hospitals. For example, Schultze & Boland Jr. (2000) argue that IT failures in

general result from the lack of understanding and awareness of the organisational

context. Thus, IT tools need to be suitable for the work context or needs. There is a

critical need to address the barriers faced in the usage of these tools, such as time

constraints, staff shortages, budget limitations, the influence of political directives,

type of culture and structure to ensure successful implementation and usage.

Excessive focus on IT without the consideration of surrounding organisational factors

could easily result in a failed system (Mohamed et al., 2006). The research therefore

contributes to the understanding of the enabling organisational conditions that

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facilitate the usage of the Intranet, as well as the impeding barriers faced in its usage,

due to the critical and dynamic nature of the work carried out in such a large public

hospital.

The methodological contribution of the research lies in the combination of research

methods utilised. These included a quantitative survey, qualitative interviews,

personal observations, document reviews, usage demonstrations and consultations

with experts over a one year period. This enabled an immersion into the research

setting and helped to draw a clearer picture and understanding, particularly of the

‘human’ side underpinning the usage of the Intranet for knowledge sharing. This

combined approach thus helped to probe more deeply than is possible with singular

research methods. It exposed the key issues involved in the usage of the Intranet and

allowed users to express themselves through extensive direct quotations on their

views and experiences of regarding the usage of the hospital Intranet.

Furthermore, these research findings add to the ongoing debate on the usage of IT

tools that support KM in achieving organisational objectives in a dynamic

environment. This research presents the case that KM is inseparable from a

consideration of modern IT tools such as the Intranet in large public organisations.

While recognizing that there are many non-technological facets to KM research and

practice, this research contests the perspective of previous research that suggests that

KM has little or nothing to do with IT. The usage of the Intranet for knowledge

sharing has its difficulties but purely human interaction for knowledge sharing at such

a large organisation would also be fraught with difficulties. Similarly, the perspective

that KM is ‘all about IT’ is challenged. IT should be considered as one of the

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dimensions of KM, but it alone would not lead to successful KM initiatives

(Mohamed et al., 2006). This research shows that IT tools such as the Intranet can

facilitate knowledge sharing. This facilitates the validating of knowledge, helping in

maintaining its integrity and creating an audit trail. This can help in reducing errors in

healthcare delivery by enabling greater efficiency and effectiveness in healthcare

services than has previously existed. This research thus lends support to those

researchers advocating an inclusive conception as well as a middle-ground between

two extremes for framing their understanding of modern IT tools that facilitate KM.

Moreover, the research findings show that without diminishing the critical role of IT

in the efficient sharing of knowledge, knowledge sharing remains as pointed out by

Huang (1998), primarily a human activity. This highlights the critical importance of

the various ‘human-based’ knowledge sharing mediums such as the face-to-face

collegial discussions that occurred at the hospital. It is however also impossible to

deny the pivotal role that IT tools such as the Intranet play in enabling knowledge

sharing. Previous research maintains that such human-based mediums for knowledge

sharing can be very slow and may preclude the organisation-wide sharing of

knowledge. This research therefore argues for the critical need to integrate the Intranet

with the popularly used human-based knowledge sharing mediums (e.g. meetings,

informal chats and informal networks such as CoP/CoI). This will ensure a

comprehensive and complementary approach, particularly where face-to-face

interaction may not be possible. This study extends the research by focusing on the

important need for IT tools such as the Intranet to complement these informal and

casual contacts among employees through improved speed of organisation, retention

and organisation-wide sharing.

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From a practice perspective, the research findings have important implications for the

development and usage of IT tools such as the Intranet, especially if they are to be

more widely embraced in public hospitals in Australia. Organisations in the public

sector are increasingly investing millions of dollars in IT tools such as Intranets to

facilitate KM and create competitive value. Given the risk that many KM tools and

systems fail to deliver the expected benefits and results, researchers have pointed out

that key enabling conditions that need to be in place are critically important. So also

are the multifarious barriers that must be addressed for the usage of IT tools to

succeed. The observations from this research reinforce the notion that IT tools are

necessary but insufficient to enable successful KM.

Finally, in support of an understanding of the practical significance of this research,

the City hospital has been able to benefit immensely from this research. The executive

management of the City hospital were provided with reports and recommendations

from the research. The developed guidelines and strategies for knowledge sharing

were endorsed by senior management and are subsequently being implemented in the

hospital.

8.3 Limitations and Directions for Future Research

Research methods can have certain limitations and the case study method is not an

exception. Frequent criticisms of the case study method focus on the issues of

reliability and generalisability.

Reliability as previously defined refers to the extent to which the findings are

replicable (Yin, 1994). Sometimes, and particularly in studies of natural settings, the

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only measuring device available is the researcher's own observations of other human

beings. As these methods are ultimately subjective in nature, results may be unreliable

and multiple interpretations are possible. In addition, the interviews conducted

required respondents to recall previous experiences or situations. Interview responses

based on recollections have the potential for bias, as more recently encountered

experiences may overshadow or skew judgments about less recent experiences. To

avoid this researcher or respondent bias, this researcher used multiple sources of

information (confluence of sources) and multiple methods of data collection. These

included interviews, personal observations, document reviews and a questionnaire-

based survey.

Frequent criticism of the case study methodology is that its dependence on one or a

few cases renders it incapable of providing a generalized conclusion or

generalisability. The number of stakeholders who influence IT implementation and

usage can be large and their unpredictable reactions to the IT tool cannot be fully

foreseen. Given this unpredictability, it is not evident that the successful usage and

impact of the Intranet in one organisation will be easily replicated in another. In

addition, previous research maintains that Intranet technology is not a ‘packaged’

technology with fixed attributes. Rather, it is a learning-intensive and highly

malleable technology that is molded and shaped according to the social forces at play

within the organisation. This makes it possible to create multiple interpretations and

effects. Thus, the same technology may manifest itself uniquely in different

organisational settings, leading to dissimilar results.

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The case study is a good method for asking “how” and “why” questions (Yin, 1994),

however a methodological limitation is that a single case study design could pose

problems in terms of generalisability. Yin (1989) however explains that the single-

case design is eminently justifiable where the case serves a revelatory or exploratory

purpose (i.e. which was the purpose of this study). Yin (1984) suggests that single

cases are the product of much qualitative research and can be very vivid and

illuminating. This is especially if they are chosen to be ‘critical’ or ‘revelatory’. Yin

(1994) further asserts that to overcome the limitations of generalisability, the

objectives of the study should establish the parameters to be applied to all research.

The use of multiple methods and the inclusion of broader issues in a single study add

rigor, breadth and depth in the understanding of the phenomenon under study thus

allowing for greater generalisability (Ellram, 1996; Flick, 1998).

The online questionnaires like traditional survey methods have certain weaknesses.

The usage of online questionnaires in this study raised a key question as to whether an

online questionnaire would unfairly exclude a section of the user population who do

not have access to the Internet, thus reducing the chance to generalise the results on

the entire user population. This study focused on the usage of the Intranet, thereby

requiring that users would have access to the Intranet. Also, to further address this

possible limitation, the results of the online questionnaire are used to indicate general

attitudes, opinions and trends. There are also certain weaknesses that are peculiar to

web-based surveys and could lead to the generation of incorrect results. According to

Roztocki (2001), some of these include multiple responses from the same participant

and less control over the respondent’s selection and transmission. In addressing these

key issues, measures were taken to ensure that these weaknesses were minimized. For

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example, allowing for single user completions only and using a properly designed

database system for the collection, storage and analyses of the data.

While case studies are a well-established form of organisational research, the results

are a product of interpretation. One of the most pressing problems with researching an

area such as KM is the rapid changes in its theory and practice. In addition, proper

justice cannot be done to the different and semi-autonomous workgroups of such a

large public organisation. As a consequence, the chosen sample is rather broad.

Furthermore, the research at the City hospital was conducted under what was

considered ‘sensitive’ circumstances. This was due to a variety of reasons. There was

a high staff shortage and turnover (particularly of nurses) in the City hospital which is

reflective of the current Australian public healthcare sector. There was also a large

cloud of uncertainty surrounding the political restructuring of the Australian public

healthcare sector which employees felt would lead to the City hospital losing its

cherished independence by being merged with an NSW State Area Health Service.

The research therefore could not focus on the differences in Intranet usage between

the various groups/specializations within the hospital (e.g. medical doctors versus

nurses). The research can be considered as an initial exploratory investigation of the

usage of the Intranet for knowledge sharing in a public hospital. This has led to

interesting findings and insights. It does however create possibilities for future

research that could be of interest to academics and managers in this area Future

research could address the usage of IT tools for supporting KM by particular work

groups in public healthcare settings, including unique enablers and difficulties

affecting the usage of such IT tools.

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It is acknowledged in previous research that Intranets are only as good as their

content. Future studies could examine the issue of control and how that affects the

usage of IT tools such as the Intranet. For example, studies could investigate how

those responsible for Intranets determine how users actually ‘use’ the knowledge

shared in their work. There is also a need to better examine who and what processes

determine the knowledge relevant for sharing via IT tools.

The conclusions from the findings of this research concerning enabling conditions or

impeding barriers may be problematic as they suggest the notion that there is a fixed

list of pre-given characteristics or barriers that may lead to success or failure. The list

of enabling conditions and barriers are therefore not exhaustive. There are other

conditions such as the influence of trust that is not focused upon explicitly in this

research. Instead, they were assumed to have happened implicitly and are highlighted

in the course of the investigation of other enabling factors such as the conduciveness

of City hospital’s culture to knowledge sharing. This is not to say that certain sine qua

non enabling factors or impeding barriers that enable the successful usage of IT for

KM in a public health organisation cannot be identified. Rather, the focus is on the

insight provided by these enabling conditions and barriers, including their issues and

complexities in such an organisation that might defy predictability and

generalisability.

A possible area for future research is conducting a comparative study between a

public and private organisation in a similar industry (i.e. healthcare), investigating the

impact of the Intranet and identifying and comparing factors applicable to both types

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of organisations. Although the argument that the differences between public and

private sectors are so great that business practices cannot be readily transferred

between them. In addition, there is no established body of knowledge on successful IT

usage for facilitating KM that can be drawn upon by organisations in the public

sector. The results of this research provide for possible future cross-learning across

sectors. However, they also show that there is no ‘one size fits all’ or ‘silver bullet’

solution regarding the usage of IT for facilitating KM processes such as knowledge

sharing. Organisations within the same industry in similar sectors implement KM

differently. Each encompasses unique knowledge assets, IT tools, enabling conditions

and barriers.

8.4 Conclusions

The purpose of this research was to investigate the usage of a modern IT tool (the

Intranet) in a modern public hospital. The research also investigated the impact of the

Intranet on the knowledge sharing process, as well as the enabling conditions and

impeding barriers faced in the usage of Intranet at the public hospital.

To survive in such a rapidly changing environment, the public hospital is faced with a

greater push and need to reduce costs and increase efficiencies while maintaining high

standards of healthcare service delivery. Furthermore, the critical and emergent nature

of the work carried out in such a knowledge-intensive work environment by highly

knowledgeable workforce in crucially short supply made the usage of the Intranet and

its impact on knowledge sharing a pertinent area for research.

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The findings of the research contributed to research in several areas. These include

KM, IT, public sector management and health informatics. The results of the

empirical studies reported in this thesis revealed the capacity of modern IT tools such

as the Intranet for transforming organisations by accumulating and sharing new

knowledge. Similar to the private sector, the public sector is facing profound changes

which suggest a need for more adaptable and responsive organisations. Modern IT

tools such as the Intranet play a crucial role today in public organisations such as

hospitals. Thus they require models that harness the benefits of modern web

technologies to aid organisational adaptability, innovation and the achievement of

their goals and objectives.

The results of this research revealed that the Intranet was able to serve the

achievement of organisational efficiency and productivity by serving as the primary

channel for internal communication and collaboration. It revealed the Intranet as

having a positive impact on the knowledge sharing process at the hospital

significantly influencing the socialisation, externalisation, combination and

internalisation processes of Nonaka & Takeuchi’s (1995) knowledge conversion

model. The various advanced features of the Intranet were able to add value to explicit

knowledge that was shared for example in the form of online reports, patient

information records, policies, manuals, meeting minutes and best practices. These

could be stored in knowledge bases (e.g. clinical information systems and the E-mail

system) to enable access. Tacit knowledge sharing was facilitated in the form of

online paging facilities for employee contacts and communication, schedule

calendars, interactive multimedia applications, online discussion forums and

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networks. It was thus able to support and enable KM and in particular knowledge

sharing at the City hospital.

Moreover, the findings of the research revealed the critical importance and popular

usage of other human-based knowledge sharing mediums by employees. Users,

despite having access to Intranet features of communication and collaboration,

preferred to ‘talk’ with other people. This research emphasises the importance of this

ancient form of knowledge sharing. It also stresses the importance of understanding

the knowledge needs and requirements of users, the social context under which

knowledge sharing occurs and how to best support and complement it with the use of

advanced IT tools such as the Intranet. What seems promising and important therefore

is the process of integrating the Intranet to complement and support other preferred

knowledge sharing mediums such as the face-to-face conversations and social

networks, rather than subjugating them to an IT solution.

The outcomes of this research highlight the need for a comprehensive and balanced

approach with regard to the usage of IT tools that support KM. It argues that

addressing KM using a purely technological or social framework endangers effective

usage of the facilitating IT tool. The outcomes of the research also show the

importance of ensuring that the enabling conditions of a knowledge sharing culture

and a flexible context-dependent structure governing the usage of the IT tool are in

place. To ensure this ‘right’ blend with the usage of the IT tool, the organisational

culture should promote and support knowledge sharing. The structure governing the

usage of the IT tool should also be adaptable enough to allow for content publishing,

presentation and updates. Yet it could be centralized in terms of maintaining content

285

quality and layout so that generic information can be easily accessed by the rest of the

organisation.

Furthermore, there is an important need to address the technical and non-technical

difficulties faced by users that could impede usage of the Intranet for knowledge

sharing. The barriers and issues identified and investigated provide an indication of

how complex public healthcare organisations are. While these issues are certainly not

confined to the public sector, they could be more than likely accentuated in a large

public sector hospital with its distinct characteristics. By addressing the barriers

affecting its usage, the Intranet can become an IT tool that transforms an organisation

such as a public hospital making it more effective, efficient and ultimately, helping to

save or give patients the benefits of extended lives.

This research suggests that the role and impact for tools such as the Intranet to enable

a range of care management and to enhance the knowledge of healthcare professionals

is of great significance to all stakeholders involved. Properly managed, adequately

resourced and tailored towards users needs, the Intranet can enhance the cognitive

capabilities of employees. It can help in dismantling functional or departmental

barriers by exposing users to the ‘rest’ of the organisation. Employing a holistic

approach would involve integrating the usage of the Intranet for employee

communication and collaboration with a support for the popular face-to-face

knowledge sharing mediums used.

Otherwise, the Intranet could also become an overwhelming medium of

communication, cynically perceived and shunned by users. This would consequently

286

result in the wastage of much needed resources and could widen the gap between

users by the reinforcement of functional barriers. Like a double-edged sword the

Intranet must therefore be handled with care, using a carefully considered and

balanced approach in its implementation and administration. An approach that takes

into consideration the organisational, technical and non-technical factors that could

affect the usage of the Intranet for knowledge sharing. This is particularly important

today in Australian public hospitals that increasingly having to do ‘more’ with limited

financial and human resources.

287

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APPENDICES

Appendix A- Online Questionnaire

A. Participant Position and Specialization

Question 1: How would you best classify your position in the hospital?

Senior management

Middle management

Supervisory role

Team member/worker bee

If Other, Please Specify

Question 2: Which of these areas do you work in?

Medical

Nursing

Clinical

Corporate/Support

Allied health

If Other, Please Specify

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B. Participant Opinions of Knowledge Sources and Knowledge Sharing Mediums

used at the Hospital

Question 3: Please rate how critical the following sources of knowledge are in the

carrying out of your daily work (on a scale from 'strongly disagree' to 'strongly agree'

where 1 is ‘strongly disagree’ and 5 is ‘strongly agree’).


5 Strongly

Agree Other employees in my unit/department

Employees in other units/departments

External partners

Communities of practice/interest

Intranet

Books (e.g. Journals)

1

Not at all 2 3 4 5

Very Often

Telephone

354

Question 4: Please rate how often you use the following mediums for knowledge sharing

with people within the hospital (on a scale from 'Not at all' to 'Very often' (where 1 is

‘Not at all’ and 5 is ‘Very Often’).

C. Participant Opinions on Usage Patterns and Experiences with the Hospital

Intranet

Question 5: How often do you access and use the hospital Intranet for your daily work?

Question 6: How much time on average do you spend accessing and using the hospital

Intranet weekly?

Less than 2 hours

2-5 hours

6-10 hours

E-mail

Shared departmental network drives

Video conferencing

Formal meetings

Informal meetings

Once a day

Several times a day

Every 2-3 days

Weekly

Fortnightly

355

11-15 hours

16-20 hours

More than 20 hours

Question 7: Please rate how often you access and use the following features of the

hospital Intranet (On a scale from 'Not at all' to 'Very often' (where 1 is ‘Not at all’ and

5 is ‘Very Often’).

1

Not at all 2 3 4 5

Very Often Documents and databases (e.g. policies and procedures)

On-the-job training (e.g. videos)

Information about services from departments

Phone numbers and paging system

Lunch menu

Organisation-wide news and communication (e.g. regular updates)

NSW Health Intranet and CIAP (Clinical Information Access Program) website

Information on vacant positions

356

Question 8: Please rate your current experience with the hospital Intranet. On a scale

from 'strongly disagree' to 'strongly agree', (where 1 is ‘strongly disagree’ and 5 is

‘strongly agree’) does the hospital Intranet adequately support:

357

Question 9: On a scale from 'strongly disagree' to 'strongly agree', (where 1 is ‘strongly

disagree’ and 5 is ‘strongly agree’), I would make better use of the hospital Intranet if:


5 Strongly

Agree Easy navigation

Easy location of documents (e.g. forms and policies/procedures)

The ability to identify the person/source of the knowledge

The availability of employees profiles and expertise

The uploading and editing of knowledge relevant to my work

On-the-job training (e.g. E-learning tools)

The sharing of documents relevant to my work

Knowledge accessed on the Intranet being up-to-date

The provision of feedback/comments

358

D. Participant Opinions on the Advantages and Difficulties Faced in the Usage of

the Hospital Intranet

Question 10: What do you find useful and important about the hospital Intranet? Please

provide examples?

Question 11: What factors do you feel impede the usage of the hospital Intranet?

1 Strongly Disagree

2

3

4

5 Strongly

Agree

It had improved search ability

I had the ability to upload relevant information directly

I had better training on how to use the Intranet

I was given time to learn how to use the Intranet

Staff profiles and skills were made available

The Intranet had quick links to documents used frequently

Best practice regarding usage of the Intranet was made available

359

Question 12: What other comments would you like to make about your experiences with

the hospital Intranet?

THANK YOU FOR YOUR TIME AND EFFORT IN COMPLETING THIS

QUESTIONNAIRE

360

Appendix B- Interview Information Statement

University of Technology, Sydney School of Management

NSW 2007, Australia

INTERVIEW INFORMATION STATEMENT

Title of Study: An Exploratory Investigation into the Impact of the Intranet on Knowledge Sharing in Organizations

The aim of this study is to investigate the impact of the Intranet on knowledge sharing including any issues that may be faced. The study is being conducted by Mr. Abdul-Hameed Oyekan and will form the basis of his Doctor of Philosophy (Management) degree at the University of Technology, Sydney under the supervision of Professor Thomas Clarke. Your participation will involve an Interview where you will be asked to discuss the use of the Intranet in your organisation. All discussions will be audio-tape recorded with the permission of all participants and verbatim transcription of the group discussion will be made. If you agree to participate in this study, you will need to attend an agreed upon location for approximately one hour on one occasion only. Participation in this study is entirely voluntary: you are not obliged to participate and if you do participate you may withdraw at any time. All aspects of the study, including results, will be strictly confidential and only the investigators named above will have access to the information. A report of the study may be submitted for publication, but individual participants will not be identifiable in such a report. If you have any concerns about the research or require further information please feel free to contact Mr. Abdul-Hameed Oyekan, (E-mail: [email protected], Tel: 0415 313 477) or Prof. Thomas Clarke (E-mail: [email protected], Tel: 9514 3479). This Information Statement is for you to keep. NOTE: This study has been approved by the University of Technology, Sydney Human Research Ethics Committee. If you have any complaints or reservations about any aspect of your participation in this research which you cannot resolve with the researcher, you may contact the Ethics Committee through the Research Ethics Officer, Ms Susanna Davis (ph: 02 - 9514 1279, [email protected]). Any complaint you make will be treated in confidence and investigated fully and you will be informed of the outcome.

361

Appendix C- Interview Consent Form

University of Technology, Sydney School of Management

NSW 2007, Australia

INTERVIEW CONSENT FORM

Title of Study: An Exploratory Investigation into the Impact of the Intranet on Knowledge Sharing in Organizations

I, …………………………………………………………………………………

[please print your name]

agree to participate in the above mentioned research project being conducted by Mr. Abdul-Hameed Oyekan, of The University of Technology, Sydney, for the purpose of his Doctor of Philosophy (Management) Degree. I am aware that I can contact Mr. Abdul-Hameed Oyekan (E-mail: [email protected], Tel: 0415 313 477) or his supervisor Prof. Thomas Clarke (E-mail: [email protected], Tel: 9514 3479) if I have any concerns about the research. I understand that I am free to withdraw my participation from this research project at any time without compromise. I agree that Mr. Abdul-Hameed has answered all my questions fully and clearly. I agree that the research data gathered from this project may be published in a form that does not identify me in any way. I also agree to have the interview audio-tape recorded and transcribed verbatim. ________________________________________ ____/____/____ Signed by ________________________________________ ____/____/____ Witnessed by NOTE: This study has been approved by the University of Technology, Sydney Human Research Ethics Committee. If you have any complaints or reservations about any aspect of your participation in this research which you cannot resolve with the researcher, you may contact the Ethics Committee through the Research Ethics Officer, Ms Susanna Davis (Tel: 02 - 9514 1279, [email protected]). Any complaint you make will be treated in confidence and investigated fully and you will be informed of the outcome.

362

Appendix D- Interview Checklist

Interview Number:

Introduce Study, Present Consent form and Ask Permission to Tape Record Theme I: Perception of Knowledge and Knowledge Management at the Hospital How would you define knowledge? What is your perception of knowledge management at the hospital? Assessment of Knowledge Sharing at the Hospital Could you kindly describe the types of knowledge shared in the hospital? Please provide examples How would you generally describe knowledge sharing at the hospital? If you could use a metaphor for this description, what would it be? How would you describe knowledge sharing within your department? How is knowledge shared using the hospital Intranet? Please provide examples. How would you describe knowledge sharing between departments? How is knowledge shared using the hospital Intranet? Please provide examples. What would you consider as critical sources and mediums of knowledge within the hospital? Please explain why? Why is the Intranet used? What features of the Intranet do you use for knowledge sharing? Theme II: Assessment of the Usage of the Hospital Intranet and its Impact on Knowledge Sharing In your opinion, Do you feel that the Intranet is able to support socialization (define and explain)? Please provide examples. In your opinion, does the hospital Intranet facilitate the process of externalization (define and explain)? Please provide examples. In your opinion, Does the hospital Intranet facilitate the process of combination (define and explain)? Please provide examples. In your opinion, does the hospital Intranet facilitate the process of internalisation (define and explain)? Please provide examples.

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Theme III: Investigation of the Key Influencing Factors Affecting Usage of the City Hospital Intranet for Knowledge Sharing Do you perceive there to be any difficulties affecting the usage of the Intranet for knowledge sharing? If yes, could you give reasons why? How do you feel they could be improved? Theme IV: Enabling Organisational Conditions and the Impact on the Usage of Intranet for Knowledge Sharing How do you perceive the culture at the hospital? Do you think it affects knowledge sharing using the Intranet? Please explain how?

Do you feel employees at the hospital value knowledge sharing? Do you find them willing to share knowledge with fellow employees using the Intranet? Could you please provide examples?

Do you view the sharing of knowledge as actively promoted and supported by senior management in the hospital? Please explain how?

In your opinion are employees visibly rewarded (financially or otherwise) for sharing knowledge? Do you feel it’s important for rewards to be used to facilitate usage of the Intranet for knowledge sharing in the hospital?

Do you view your department/unit and the organization as ’one team’? Does this affect the usage of the Intranet?

Theme V: Assessment of the Structure Governing the Intranet and the Impact on the Usage of Intranet for Knowledge Sharing What is the type of structure governing the hospital Intranet? Do you feel it’s appropriate for usage of the Intranet for knowledge sharing? Why? Does the current structure affect knowledge sharing using the Intranet? How? Conclude and ask if interested in making any other comments.

Thank You Very Much for Your Time.