The usage of the intranet and its impact on organisational knowledge sharing : an exploratory investigation of a public hospital
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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 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? 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. 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-toface 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. 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 nontechnical 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 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.
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