In terms of the links between knowledge and innovation, whereas production approaches see a direct relationship between an increased quantity of knowledge stocks and innovation (Amidon, 1998), process accounts view such links as socially and politically mediated. Thus, innovation is seen as: “the development and implementation of new ideas by people who over time engage in transactions with others in an institutional context” (Van de Ven, 1986).
Such accounts view innovation, not as involving the transfer of knowledge from one type or location to another, but in a dynamic way, as involving the coming together of different organizational tasks, multiple actors, and multiple forms of knowing (Clark and Staunton, 1989). Whether or not knowledge generates innovation depends, then, on both the particular interests and interpretations of actors that interpret, produce and legitimate it, and the social and institutional contexts in which actors are located. For example, Clark (1989; 2003) describes how innovation, in the form of the US game of American Football, emerged originally from the UK game of Rugby. However, it was not simply a case of capturing knowledge about the game in the UK and transferring this to the US. Rather, this knowledge had to be appropriated for the US context. In particular, the involvement of key stakeholders (e.g., US media, sports promoters and advertisers) led to “pivotal modifications” in the game (e.g., the introduction of shorter periods, kick forwards, and “time- outs”) in order to adapt it for the US (Clark, 1989). Similarly, in the Cataracts case, both the development of the innovation, and the failure to appropriate it in other hospitals reflected, in large part, the vested interests and interpretations of the different groups of specialists involved. For example, the secretaries initially interpreted the new system as making their own jobs more difficult and, so, attempted to usurp it. Also, the performance measures produced in East General were not seen as legitimate in the context of other hospitals, in part because it was not in the interests of those in other hospitals to admit to relatively poor performance.
These examples highlight the central role of social networks, in translating (not just transferring) knowledge in such a way as to promote the interests of particular social groups, as well as the need to take into account variation in the institutional contexts in which they are located. For example, in the Cataracts case, networks were used extensively by the transformation team member to legitimate the new process and mitigate conflict. Recognizing that the links between knowledge and innovation are socially and politically medi- ated, also provides some clues as to why it is that many innovation processes (including KM initiatives) fail, despite knowledge being apparently available.
For example, the Qwerty keyboard—originally required when typewriters used mechanical “hammers” for letters—has continued to be dominant to this day, despite evidence that an alphabetic keyboard would be more efficient because numerous social groups (e.g., teachers, manufacturers, trained typists) have a vested interest in maintaining the status quo (Rogers, 1995).
Practically speaking, process approaches to KM focus on knowledge sharing and translation, rather than knowledge transfer. The major task for
KM, then, is to build “boundary spanning” mechanisms for connecting social groups and interests and for developing shared understandings, identities and perspectives (Boland and Tenkasi, 1995). The recent surge in management initiatives aimed at building, so-called “communities of practice” (Wenger, 1998), or initiatives aimed at “social network analysis” (Cross and Sproull, 2004) reflect such a view. Similarly, “second generation KM,” “community”
(Swan et al. 1999), “network” (Alavi, 2000) and “personalization” (Hansen et al. 1999) strategies all emphasize the value of creating opportunities for the development of social networks and trust-based relationships (e.g., Gupta et al. 2003), since it is through such relationships that new meanings and understandings can come to be shared and applied to tasks. KM tools might also include the development of IT, not as a means to transfer information, but rather as a means to establish and reinforce social networks and communities, and a context for knowledge sharing.
4.1 Implications for KM at East General Hospital
The process perspective is clearly a useful lens through which to see the issues encountered at East General Hospital. They stress, for example, the inherently uncertain, open-ended and politicized nature of knowledge and innovation.
Here, then, a process model of innovation as involving a set of complex and recursive interactions among different sub-groups, agendas and forms of knowledge (e.g., consultants, optometrists, secretaries, nurses), is perhaps a better account of what happened (e.g., Clark et al. 1992; Garretty and Badham, 2000). According to process perspectives, knowledge is subjective and privileges the meanings and interests of particular powerful social and professional groups. The failure of the secretaries to effectively resist the new system, for example, is a reflection of their relative lack of power in the face of other professional groups.
Recognizing the social and politicized nature of innovation means that attempts to manage knowledge would need to be sensitive to the interests and interpretations of the different groups involved. Whilst this sensitivity was clearly displayed in the process of creating knowledge within the East General team—for example, through the large number of meetings aimed specifically at sharing views amongst professionals—it was not so visible in the process of attempting to transfer this knowledge to other hospitals. The failure to transfer the, apparently, successful, new treatment, can be explained as a failure to take proper account of the culturally and politically mediated nature of organizational life (Newell et al. 2002). As Dougherty and Heller (1994) note, innovations fail because they “violate the existing systems of thought and action, or fall into a vacuum where no shared understandings exist to make them meaningful” (p. 201).
A practical implication of a process view for KM in this case might have been to establish closer social ties linking members of the East Midlands team with groups of specialists in other hospitals. As Boland and Tenkasi
(1995) notes, in organizations the problem of sharing knowledge “is not a problem of simply combining, sharing or making data commonly available.
It is a problem of perspective taking in which the unique thought worlds of different communities of knowing are made visible and accessible to others”
(p. 39). However, it is also worth noting that, even where specialists in other hospitals did share an understanding of the new system, and could see how it would benefit their own hospitals, they still had difficulties putting this knowledge into action. In other words being able to understand and translate the knowledge was not sufficient to transform this knowledge into action within their own contexts. Practice perspectives, which we will next examine, provide further insight into these problems.