5 Practice Perspectives
5.1 Implications for KM at East General Hospital
Relating practice perspectives to KM and innovation, it can be seen that innovation—especially innovation that cuts across established practices as in the Cataracts case—by definition, needs practices to change. Existing knowledge and practices need to be displaced, transformed (in Gidden’s terms “disembedded”) to make room for new practices (Giddens 1984).
This highlights both the discontinuous, non-linear, nature of knowledge and innovation, but also the disconnects between knowledge and innovation. For example, even with the best designed KM initiatives, even where different groups come to understand and appreciate one anothers” perspectives, and even where there is significant commitment to change, change itself is difficult.
This is, in part, because invested practices need to be divested. For example, in the Cataracts case, even where professionals in other hospitals saw the need for change and understood what was required, they were still unable to implement change within their own “field of practices.” In sum, whereas production and, to a lesser extent, process accounts see the creation and flow of knowledge and innovation as a relatively seamless, or smooth, process, provided appropriate conditions and processes are in place (e.g., Nonaka, 1994; Zollo and Winter, 2002), practice perspectives highlight the patchy, uneven and discontinuous nature of knowledge and innovation due to investments in practice.
Practice perspectives highlight the possibility for objects (including KM technologies) to play a critical role in KM (Carlile, 2004). As seen, practices are in part constituted through material non-human entities.
This means that objects (including discursive objects) could play a critical role in constituting and transforming practices. In the Cataracts case, the forms designed by the project team played a number of important and diverse roles. Firstly, they revealed what kinds of practices currently existed, including the interdependencies between the practices of the different groups involved (e.g., consultants and optometrists). Secondly they revealed gaps in understanding and encouraged “perspective taking” across specialist groups (Boland and Tenkasi, 1995). Third, they engaged different specialist groups in the process, so encouraging commitment. Finally, they generated a new set of collective practices around diagnosis and assessment.
Thus, whereas KM initiatives based on production perspectives see objects (e.g., technologies, reports, databases) as a means of transferring knowledge, practice perspectives alert us to the possibility for objects to be deployed to progressively transform knowledge.
Looking more closely, Carlile (2002) presents a typology of different kinds of knowledge boundaries and associated boundary objects that might be useful to consider in thinking about KM (see also Star and Griesemer, 1989). The first type—the syntactic boundary—refers to differences centerd in grammar, symbols, labels and languages. Here, the problem of knowledge sharing amounts to being able to “match differences” by using a common syntax across the boundary between the message “sender” and message “receiver.” Where practice is, to some extent, shared, Carlile argues that it might be possible to transfer knowledge provided that syntax is shared. The role of objects, then, is to develop a common syntax. However, a common syntax does not necessarily mean that actors understand objects in exactly the same ways. Thus, at the syntactic boundary objects “do not convey unambiguous meaning, but have instead a kind of symbolic adequacy that enables conversation without enforcing commonly shared meanings” (p. 362 Boland and Tenkasi, 1995).
For example, in the Cataracts case patient information and referral databases helped to establish common practices across consultants and optometrists for structuring information. This, in turn, promoted knowledge (or information) transfer across these groups (Briers and Chua, 2001). However, it does not mean that the information taken from the database will necessarily be interpreted and deployed in the same ways by these different groups or by groups in other regions.
Semantic boundaries refer, then, to differences in accepted interpretations and meanings amongst actors at a boundary (Carlile, 2002). At semantic boundaries, the critical issue for KM appears to be “perspective taking”—the process whereby social communities come to recognize and accommodate differences in interpretations such that “the unique thought worlds of different communities of knowing are made visible and accessible to others” (Boland and Tenkasi, 1995, p. 359). Translating, rather than transferring, knowledge is central. At a semantic boundary, objects (however, interpreted by actors) may help to reveal and accommodate differences in perspectives and, so, “reconcile differences in meaning” (Nonaka and Takeuchi 1995). Thus, in the Cataracts case, the use of various tools and protocols (e.g., standardized forms, process diagrams and templates) played a critical role in revealing and reconciling differences and translating knowledge across specialist groups (see also Carlile, 2002; Wenger & Snyder, 2000). Since objects are themselves social constructs, there is clearly also a relationship between human agency and the translational capability of objects. For example, studies of communities of practice highlight the roles of intermediaries or “knowledge brokers” in the development of communities (Wenger & Snyder, 2000). Also, objects that have sufficient
“interpretive flexibility” to be seen as “desirable” across groups with different interests and political agendas—such as, in this case, the “transformation team” itself—may play a powerful role in generating commitment to a shared course of action.
A third, and less well recognized, knowledge boundary is pragmatic which, as Carlile (2002) notes, stems from the investment of knowledge in practice, discussed earlier. This recognizes not just differences in meanings, but also the considerable effort and history invested in practices and the interdependencies between practices. For example, in attempting to resist the change, secretaries at East General realized that hospital practices for theatre scheduling were dependent on their access to individual consultants’ diaries. A critical role for objects at pragmatic boundaries is knowledge transformation—i.e., to encourage specialists to translate each other’s knowledge and practice and also to transform their own practices as a result. Here, then, important objects for KM could include maps or “coincident boundaries” (Star, 1989). These are objects—such as work plans, flowcharts, and process maps—that, both specify differences in world views and also specify interdependencies between them (Gerrarty and Badham, 2000). Such objects might, for example, have been useful in the Cataracts case for making knowledge from the East General case actionable within other hospitals. However, those responsible for KM need
also to be aware that objects (including KM systems themselves) can also be sites for significant conflict—“creating and reshaping boundary objects is an exercise of power that can be collaborative or unilateral” (Boland and Tenkasi, 1995, p. 362).