I was meeting with my leadership team recently and prepping them for a staff training event. I introduced them to the concept of tacit knowledge. Of course, they had not heard the term before, so I had to explain what it was. Over the next few weeks I found them using the term correctly in other conversations and realized I had found a way to express appreciation for their experience they found to be validating.
Shortly thereafter I was meeting with colleagues and talking about a project now underway designed to measure the impact of staff turnover on dialysis unit operations. As part of that process, I asked a dozen experienced managers and administrators to ponder what they thought were “best practices” contributing to staff turnover. This line of thought led me to the question of what as been termed “knowledge management.” This concept is fairly new, but I found an excellent summary of the process in a work published in 2003 by the Organization for Economic Cooperation and Development.
The introductory chapter by Foray and Gault points out that active, deliberate management of organizational knowledge is necessary because:
“Firstly, some of the older practices buried in human resources and employment policies, which helped with knowledge management, no longer work. For example, memorization and transmission of tacit knowledge has always been insured by internal institutions (the craft guild, the internal labor market) and external organizations (professional networks) in which this was an essential function. However, these institutions have largely disappeared or find themselves in profound crisis…
Other practices no longer work. The principle of lifelong careers and long-term attachment to the company led to a kind of common destiny between the employee and his/her company…”
Secondly, the imperative of innovation as a condition of business survival has forced the introduction of explicit forms of knowledge management.
In considering the question of how to implement knowledge management, they note there are two broad options:
“Personalization: knowledge remains in its tacit form and is closely bound to the person who develops it; it is shared primarily through person-to-person contact. To make this strategy work, companies invest heavily in networks of people…In a sense this strategy is simply another form of traditional “internal labor market” as a powerful mechanism for capitalizing on, transferring and sharing knowledge. Both the problem and the knowledge are unique, and the service is expensive and time-consuming.
Codification: knowledge is transformed so that it can be stored in databases and then easily accessed and used by anyone in the company; while codification involves high fixed costs, it enables agents to perform a number of operations at very low marginal cost. This model is appropriate for…[organizations that]…deal repeatedly with similar problems. For them the efficient reuse of codified knowledge is essential, because their business model is based on fast and cost-effective service, which an efficient system of knowledge reuse provides…
Of course, all firms and organizations use both strategies, but the hypothesis is that those that excel focus on one and use the other in support…”
In a second introductory chapter by Quintas, the issue of practical application of these concepts is considered. He notes:
“There are fundamental issues that must be considered in relation to knowledge capture, whether the approach is Taylorism or more modern equivalents. First, not all knowledge held by individuals is codifiable…Therefore knowledge is neither wholly open to capture or to transfer to others via language. Important forms of knowledge…can only be gained by experience. Further, knowledge is context-specific—it is created in relation to specific time and specific social, technical, market, and locational contexts. The downstream use of codified knowledge requires meaning to be interpreted in a different context from that in which the knowledge originated.
Knowledge sharing implies learning, since learning is a process of acquiring knowledge…The learning process of the recipient is largely assumed to be unproblematic.”
For dialysis nurses the learning process is not trivial. Experience suggests it takes about a year for a nurse to acquire the formal learning to be an effective dialysis nurse and it takes about three years to achieve a level of mastery that is truly productive in terms of organizational knowledge. So clearly there is a need for mentoring to “pass on the lore,” but there are also opportunities to codify the organizational learning and transfer it from tacit to formal knowledge, which are done through policies and procedures, in-services, and skills testing. But some of the knowledge remains embedded in local practices and customs no matter what formal processes are in place at the organizational level. I suspect the effectiveness of the local practices and customs is a manifestation of local leadership, or what I have termed clinical leadership.
So what should the principal knowledge management strategy be in the context of a dialysis clinic—personalization or codification? I suggest the former is the only approach likely to achieve superior results. But I fear the industry is dominated by the latter, as it is assumed all dialysis procedures are basically the same. Unfortunately, patients are not all the same, and even the same patient is not always the same.
31 October 2015
 Accessed 29 October 2015 at https://books.google.com/books?id=7eXT8JSQztEC&pg=PA64&lpg=PA64&dq=measuring+management+practices+employee+turnover&source=bl&ots=QLdDmfSuO9&sig=4GG-ULwJGTQgm-pks_i4EB-NIPU&hl=en&sa=X&ved=0CF4Q6AEwCTgKahUKEwiqs6_dqOjIAhUBPCYKHXp9CQ0#v=onepage&q&f=false.
 Foray D and Gault F. Chapter 1. Measurement of Knowledge Management Practices, in Knowledge Management—Measuring Knowledge in the Business Sector: First Steps. (reference above), pp. 12-20.
 Quintas P. Chapter 2: Managing Knowledge in Practice. In reference above, pp. 39-40.
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