Volume 8 Issue 7 - May 1, 2009
An exploratory model of knowledge flow barriers within healthcare organizations
Chinho Lin1,*, Bertram Tan2, Shofang Chang3

1Department of Industrial Management Science & Institute of Information Management, National Cheng Kung University, Tainan, Taiwan, ROC
2Institute of Business Administration, Kun Shan University of Technology, Tainan, Taiwan, ROC
3Institute of Health Information & Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan, ROC

Information & Management, 45(5), pp. 331-339, 2008

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Healthcare IS today are mainly knowledge-based and the diffusion of medical knowledge is imperative for optimal treatment of patients. Our study of the industry explored barriers to knowledge flow using a Cultural Historical Activity Theory (CHAT) framework. Our work was exploratory and qualitative in nature, and consisted of three phases: in-depth interviews to explore medical knowledge flow barriers resulting in a model; a case study using a survey approach to test and modify the model; and a Delphi study to validate the generalizability of the model.
Figure 1 CHAT applied to knowledge flow

2.Determinants of and barriers to knowledge flow
Knowledge flow barriers into the categories shown in Table 1:
Table 1 Barriers to medical knowledge flow

3.Research process

●In phase I. 25 physicians from 7 different hospitals were involved;
●In Phase II, 129 physicians from a medical center were used; and
●In Phase III, 20 experts or middle medical managers were interviwed. The research process is shown in Figure 2.
Figure 2 Research process


In Phase I, we classified medical knowledge barriers and derived two propositions which are as follows:
Proposition 1: Medical knowledge flow barriers can be classified into five categories: knowledge source barriers, knowledge receiver barriers, characteristics of the knowledge transferred barriers, contextual barriers, and insufficient mechanisms.
Proposition 2: The five categories of medical knowledge flow barriers are not independent; they affect one another.

In Phase II, we revised proposition1 is as followed: ”Medical knowledge flow barriers can be classified into five categories: knowledge source barriers, knowledge receiver barriers, knowledge transferred barriers, knowledge flow context barriers, and organizational context barriers;” and tested of proposition 2 which is supported.

In Phase III, we derived the final model which is depicted by Figure 3:
Figure 3 Final model: revised CHAT applied to medical knowledge flow


Our approach was the first to emphasize the importance of context between “knowledge sources” and “receivers”, since previous studies concentrated only on the organizational context.  It complemented the original CHAT theory and is the first to propose a holistic model concerning medical knowledge flow in terms of five knowledge flow barriers. It allowed for the complexity of the context and diversity of stakeholder perspectives.
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