Análisis de la Situación Externa 1 Los clientes

Organisational capabilities describe the capabilities or tools that an organisation such as a hospital requires to enable it to obtain and exploit knowledge from its environment (Volderba et al, 2010). Capabilities allow new sources of

knowledge to be identified, incorporated and used within the organisation. Volderba and colleagues (2010) described three tools which could be used to improve organisational capabilities. These are co-ordination, systems and socialisation capabilities (Volderba et al, 2010). Co-ordination capabilities are the skills owned by staff members who work in the organisation. In my study, this may be the communication skills or the education and training of clinicians and staff. The use of boundary spanners, and networked CoP may also increase co-ordination capability by increasing the use of decentralised authority (Waring et al, 2014). Knowledge source Experience Potential Acquisition Assimilation Realised Transformation

Exploitation Competitive advantage

Systems capabilities, on the other hand, represent formal knowledge of an

organisation and can include policies, procedures and clinical pathways aimed at transferring codified knowledge across the organisation (Volderba et al, 2010). Systems capabilities can, however, limit the discovery of new knowledge because staff become fixated on maintaining procedures and regulating the behaviour of individuals, rather than searching for new information elsewhere (Waring et al, 2014). Therefore, the way in which the knowledge is created and shared within the organisation may influence whether it is used or not.

Finally, socialisation capabilities reflect the cultural factors within the

organisation which influence knowledge sharing. They represent the shared norms and understandings of people working in an organisation (Volderba et al, 2010). As expected, staff with similar norms and understanding are better able to transform and exploit new knowledge as they have the same frame of

reference. However, as mentioned previously, norms can also limit knowledge mobilisation when they restrict knowledge assimilation because it does not fit with what is expected (Volderba et al, 2010).

According to Cohen and Levinthal (1990) it is easier to absorb external

knowledge when it is linked to knowledge that already exists in the organisation. To improve this process an organisation needs to be able to appreciate and understand the potential value of the new external knowledge for their current situation, e.g., why would the NICE guidance help them in their practice? It will be important to examine and understand the system and wider organisational cultures of the hospitals in the empirical setting to examine the organisational knowledge and how it is used.

To improve knowledge sharing within hospitals, it is necessary to recognise the different processes (i.e., capabilities) underlying internal and external drivers of knowledge and the interactions between them. In a similar way to the concept of clinical mindlines, ACAP is not an object that can be explicitly examined in

isolation. The context of study is important and this needs to be measured and captured. The external environment may also determine incentives for

improving ACAP, for example, local competition between hospitals and new regulations may restrict or facilitate ACAP activities. The internal environment is similarly important as it will potentially influence the efficiency and

effectiveness of organisational ACAP, but it may also constrain what knowledge can be integrated and used. In order to focus on knowledge mobilisation, organisations might need to move away from rigid structures towards a more flexible approach. A focus on ACAP could influence the strategies that hospital managers tend to adopt to change the existing structures and processes towards learning and innovation.

2.5

Chapter summary

The epistemological debates surrounding knowledge and knowing may, at first glance, seem inappropriate for the study of how surgeons working in the NHS make decisions for patients. However, it is essential for me to ground the research in the theoretical understanding of what knowledge is and how it is mobilised. The use of evidence in clinical decision-making for orthopaedic surgery is a knowledge problem, as variation has been found in the process of knowledge acquisition, the way evidence and knowledge are mobilised in

hospitals and the knowledge brokering that occurs in individual surgeons’ heads (Grove et al, 2016). Each of these may be important for understanding variation in practice.

An outcome could be a clinical decision or new innovations, new knowledge or new products or new ways of using knowledge which neither tacit nor explicit knowledge could have produced in isolation. It is the context of clinical practice, the interaction with the social and physical environment, which is important for my research, as clinical decisions are made in complex social and physical environments. This leads to questions about how organisations such as hospitals can encourage the sharing of knowledge, including evidence-based guidelines, across individuals and groups. It will also be important during my empirical work to try to understand how to create the social or contextual situations which can support surgeons, working in hospitals, to develop new ways of knowing and new ways of practising that are inclusive of EBM.

The theoretical perspectives introduced in this chapter have been developed to explain and improve knowledge mobilisation between individuals and groups and in organisations. The aim of including these theories was to provide a context and background from which to develop my empirical research. I

described clinical mindlines, Communities of Practice, organisational knowledge, boundary spanning and Absorptive Capacity.

The theories of knowledge mobilisation are clearly useful and applicable to my study, specifically because they take account of context, rather than excluding context. They help us to understand how healthcare organisations can

encourage the sharing of knowledge among individuals and groups. Theories facilitate ideas about the creation of social or contextual situations which support people and organisations to develop new ways of knowing and new ways of practising knowledge mobilisation in healthcare.

The next chapter introduces the research questions and research methods for my empirical work.