While the redesigned cataract process was considered to be highly successful in the hospital where it had been developed, the diffusion of this newly designed process to other hospitals was extremely problematic. For example, in one hospital which had been sent the paperwork about the new process in East General Hospital, the idea had been rejected because it was seen as “too radical.” Indeed, even within East General Hospital itself, consultants who had not been involved in the reengineering project still assumed that optometrists could not properly diagnose cataracts and continued to want to see all patients themselves to make the diagnosis.
Recognizing these problems, significant effort was put into capturing and disseminating user-friendly documentation, and “blueprints” (referred to as the “Roadmap”) for implementing the new “best practice” cataracts treatment process in other hospitals. However, these were having relatively little impact. Faced with this, the transformation team hosted a number of networking events aimed at explaining and illustrating the process “live” to members of other hospitals. Whilst this generated significant enthusiasm at the events themselves, still relatively little happened and, two years on, East General Hospital remained the only one to have implemented the new process.
McElroy (2000), for example, refers to this approach as “first generation KM”;
Hansen et al. (1999) refer to “codification” strategies; Swan et al. (1999) use the label “cognitive” (see also Newell et al. 2002); and Alavi (2000) describes it as the “repository” approach. These authors also note the dominance of production perspectives in early articles written on “knowledge management”
(Scarbrough and Swan, 2001; McElroy, 2000). For example, Scarbrough and Swan (2001) found that, whilst the problems of managing knowledge had been a core issue in management for a long time (since Taylor’s time and beyond), the mid 1990s saw an exponential growth in articles written on “KM” and around 70% of these were focused on the capture and transfer of knowledge through the use of information technology. It is probably no coincidence that this heralding of “KM” aligned with a concurrent upsurge of interest in the “knowledge-based economy” and the “resource-based view of the firm”
and significant advancements in internet technology. It also chimed well with the traditional artifact-based model of innovation, which saw innovation as more or less linear process involving the creation and transfer of technological artifacts from one location (e.g., in scientific laboratories) to another (e.g., in industrial firms). A common feature of these different areas of interest was an emphasis on knowledge accumulation and transfer.
Sometimes production perspectives are also sensitive to the fact that, unlike other resources, a significant amount of knowledge is not actually owned, or controlled, by the organization. Rather, because of its tacit qualities, important knowledge resources reside with individuals. Individuals may choose, or not, to share their knowledge with others, or may leave the organization. This makes the organization vulnerable to the problems of not being able to exploit its knowledge resource, or seeing it, literally, “walk out of the door.” KM, then, is presented as the solution to this problem—through IT systems, it is assumed, the tacit knowledge of individuals and groups can be captured, made explicit and converted into an organizational resource. The focus on using IT to systematize knowledge has strong resonance with earlier Scientific Management approaches to dealing with the vagaries of craft-based production and craft workers.
In sum, then, the assumptions underlying the production perspective are that: (i) knowledge lies in the heads and minds of individuals; (ii) creating and transferring knowledge involves the conversion of one type (e.g., tacit) to another (e.g., explicit); (iii) valuable knowledge can be objectified (it can be captured); (iv) knowledge is functional (i.e., it is fundamentally good for innovation); (v) innovation involves a linear process of creating knowledge in one place and transferring it to another and; (vi) knowledge management activities involve the development of systems and processes to help the capture and transfer of knowledge. Broadly speaking, the dominant paradigm underpinning these assumptions is functionalism (Burrell and Morgan, 1979) and the dominant epistemology is a “knowledge as possession” view (Cook and Brown, 1999)—i.e., knowledge is seen as a resource possessed by individuals, groups, and organizations. Nonaka and
Takeuchi’s (1995) “knowledge creation cycle”—focusing on the conversions between tacit and explicit knowledge—echoes elements of this view (despite claims to its socialized nature).
Entitative assumptions about the status of knowledge as an object, or variable, to be manipulated to achieve certain ends, have been challenged by interpretive paradigms and social constructivist theories which highlight the inherently subjective, and highly equivocal, nature of knowledge (Weick, 1990; Bijker et al. 1987). For example, the “knowledge as possession”
view (e.g., Blacker, 1995; Tsoukas, 1996), has been criticized for failing to address the situated nature of knowledge in social and organizational context (Tsoukas and Vladimirou, 2001; Lam, 2000). The linear view of innovation and the knowledge conversion process has also been subject to debate, with critics arguing that linearity is little more than a feature of retrospective and rationalized descriptions of innovation and knowledge creation processes. These descriptions, it is argued, gloss over the discontinuities, iterations and political uncertainties that characterize all but the most simple innovation processes (Clark, 2003). For example, in the Cataracts case, political uncertainties amongst optometrists and secretaries played a key role in both shaping and interrupting the innovation process.
A number of writers have pointed out that too great an emphasis on stockpiling knowledge, as a valuable resource in its own right, risks divorcing KM from outcomes (McDermott, 1999). For example, there is no particular reason, a priori, why innovation should follow from capturing and transferring more and more stocks of knowledge. Rather, information overload and existing knowledge might, quite conceivably reduce innovative capability. For example, in the Cataracts case, knowledge produced in the form of new forms and templates was able to be used by the consultants and optometrists within the East Midlands hospital because, by working together, they had come to reframe the problems they were dealing with.
However, despite being available, this knowledge was not useful to similar groups in other hospitals who saw the problem through their own existing frames of reference. Thus knowledge should not be seen as valuable in itself, but as adding value only where applied for specific tasks (McDermott, 1999).
This has led to the development of more sophisticated contingency theories that link different strategies for managing knowledge to specific aspects of the tasks at hand. For example, Hansen’s (1999) study of innovation in a large electronics company concluded that strong ties were beneficial where tasks require the transfer of complex (often tacit) knowledge, whereas weak ties were more efficient where the knowledge involved was less complex (often explicit).
As well as these theoretical objections, there are practical concerns with the production approach—KM initiatives based on this kind of thinking frequently fail (Walsham, 2002). In one empirical study of an initiative to encourage knowledge transfer in a world-wide bank, Newell et al. (2001) found
that the introduction of a KM system actually had the opposite effect to that intended by senior management. In this case, intranet technology was introduced to encourage global knowledge sharing. However, once available, this technology infrastructure was appropriated and deployed very differently by the different groups and divisions in the bank with the result that, instead of encouraging knowledge sharing through one global intranet, more than 150 different intranets were developed, effectively strengthening the boundaries and divisions around existing groups with “electronic fences.”
3.1 Implications for KM at East General Hospital
As seen, the production perspective can be seen in some of the thinking of transformation team members at East General Hospital and, despite criticisms, is also pervasive in many KM initiatives (Newell et al. 2002).
For example helped by the transformation team, knowledge about the new treatment process was captured in the form of new assessment forms and Roadmaps, supported by objective measures of the effectiveness of the process (e.g., patient satisfaction scores and waiting time measures). Indeed the very idea of the transformation team—to roll out best practice invented in one hospital to be used in another—is also a reflection of the linear, production view. For East General itself, these objectified forms and Roadmaps were helpful in developing the new treatment process and in negotiating the roles and responsibilities of different specialists. However, the limits of this approach are also evident in the Cataracts case. In particular the Roadmaps were unable to be adopted by other hospitals, and the measures of success were read by some with disbelief. Even those consultants and optometrists that could see that the new system was actually working at East General, then failed to appreciate how it could be made to work in the context of their own hospitals (East General being painted as somehow “special”). The response of the transformation to these issues was to “step up” their knowledge transfer activities and improve the information. However, this had little effect.
A critical problem in this case was that, whilst these objectified forms and templates were able to depict what the new system should look like, they failed to capture the processes by which this knowledge had been produced.
These included, for example, intensive negotiation and trust building, personal networking, and informal opportunistic meetings, such that the different specialists involved came to appreciate one another’s perspectives and to develop a more collective understanding of the treatment process. In other hospitals, where traditional methods were still used and this collective understanding had not been developed, even with the best intentions, the specialists could not appreciate how to apply the new template in their own context (Newell et al. 2003).