Knowledge and IS

As Walsham et al (1988) claims ’information systems in organizations are not just technical but should rather be conceptualised as social systems in which technology is only one of the dimensions’ and ‘social systems because they concern interplay of human, organizational and technical factors which cannot be easily separated.’(Walsham, Waema and Symons 1988) An information system is thus not only technical systems, but also the social factors around a working process. Technical Information systems can be used as a facilitator and a medium to create efficiency, but it is important to carefully define how it shall be used in order to maintain the strengths of the professional bureaucracy.

The view of organizations as knowledge systems, built and developed through situated practice (based on competency and experience) where much of the knowledge is tacitly embodied and difficult to explicate and separate from the specific situations, implies a critique of the knowledge management strand. This strand treats knowledge as decontextualised objects which are universally applicable, and separated from the subject who knows. Within the IS literature there are several studies which are well aligned with this critique. Thompson and Walsham (2004) describe a case study where an IT organization tried to import a practice where subjects had to register their knowledge in repositories (in order to make it explicit). The project included three types of KM initiatives: collecting data, codifying information and generating meaning. The first project was not successful as the subjects did not see the point in registering their “knowledge” in repositories. This was ‘information which they would have been happy enough to have provided through communicative interaction’ (ibid: 731). Regarding the second the authors found that in situations where technology was tailored to specific groups, initiatives were successful, but that these tailored products could hardly be used outside its context. A problem related to this second point was the inability or impossibility to write up “in-between lines” information obtained in interaction with clients (ibid: 732). The third was seen as the most successful as it implied some sort of continual inter-subjective communication between individuals (ibid: 733). This KM initiative was basically based on corporate yellow pages, informal interaction, interest groups and e-mail. As it “cultivated” the face-to-face interaction (instead of trying to replace it) it was more aligned with the way the consultants worked and consequently more successful. This was successful, because the knowledge was not separated from the context. The authors conclude by saying that the ‘importance of contextual analysis is necessary if organizations are to avoid the

mistakes of the past and ensure better targeting of their investments in methodologies, best practice, application software, special interest groups, and other forms of support for shared organizational endeavour.’ (ibid 743) Other IS literature criticizing the knowledge-as-decontextualised-object literature is Walsham 2001, 2005), Walsham and Barrett (2005), and McDermott (1999), while Brown and Duguid (1998) also touch technological aspects of knowledge management. All of them emphasize the importance of understanding knowledge as something related to the context where people know and learn through interaction. This means that cultivating processes is a sounder strategy than pursuing objects (or ‘knowledge’) to be registered in repositories (Thompson and Walsham 2004). Human thought is often tacitly embodied and in order to design Information Systems for knowledge management (like the EPR), the members of different communities must participate in the development. The system must provide information while the organization at the same time upon this layer of information, enables and cultivates interaction. This also means that Information Technology is seen as a possible provider of information which can stimulate participation and simplify things for the different communities. Walsham (2001) outlines possible improvements in KM strategies being facilitating communication done by individuals in CoPs; appropriate reward systems; and the creation of safe enclaves (ibid, see also Berg and Goorman 1999). These authors thus identify themselves within the area knowledge-as-practice, as they see ‘knowing-in-practice as an individual process, inseparable from practical action, with knowledge communities as key learning areas, and taking place in contexts where power relations matter’ (Walsham and Barrett 2005:7).

We can see that there is a struggle between how much it is possible to encode in repositories, and how that should be encoded. As we have seen the problem is to find the balance between encoding and facilitating. While organizational information systems (like EPRs) are established in order to define, collect, and share information which is relevant for the organization, thus can seen as organizational knowledge management systems, the lay people have to a limited degree this “luxury”. The information engine for the lay people is basically the Internet, and I will briefly introduce some aspects related to this.

Internet and lay knowledge

Internet is seen as a possible challenger to traditional role configurations, and is an extensive

“library” where lay people can access information. I will thus briefly touch upon issues relating to implications of Internet use amongst lay people.

The Information Society and the modern life, with Internet and additional information resources, as well as an increased focus on consuming, challenges the traditional role configuration within the health system (Hafstad 1999, Hardey 1999, Hjortdahl, Nylenna and Aasland 1999, Coultier 1999) as the Internet enables a “sharing of power” between key actors like physicians and self-management groups (Dickerson and Brennan 2002:198). It also has enabled new patient roles (Bellika and Larsen 2001). Internet is however not a structured tool where information is controlled and portioned, and as Hannemyhr (2005) claims, there are many problematic aspects connected to it. Dickerson and Brennan (2002) identify three common ideologies regarding the ability of Internet as a power structure in patient-provider relations. Let us call them the conservative, the positive and the capitalistic elements. The conservative is about how Internet information creates excessive burdens on the health profession as the doctor then has to help the patients to search for “good” information. The second is about how technology is seen as a good which will improve life. The third regards the superiority of the market structures and how market forces improve quality and reduce cost. The authors claim that Internet has the ability to shift the power between provider and patient, and identifies two ideologies which support reform.

First the egalitarian which focus on giving broad access to information and enable Internet access from public facilities. As a result of the knowledge enhancement obtained by this point, the lay people can participate more actively. The health resources then have to be effectively allocated in order to serve the empowered patient. We can thus see that Internet has important implications as well as challenges for the health profession. Internet is both a part of Information Society as well as a medium which itself creates more information. The consumer society with privatization of health institutions, and these institutions needs to market their services through media, makes information available also for the layman. Internet thus enables lay people to access information formerly regarded as “secret” and hidden from them. In these matters the Internet is an important medium, but it raises some problematic issues as well, as Dickerson and Brennan notes.

Till now I have described knowledge in hospitals as to a large extent embodied. It is obtained, used and distributed through negotiations, discussions and cooperation in practice. The practice is performed within and between communities of practice. The difference between professionals and lay people is that professionals have to categorize across unique individuals, while lay people mainly focus on their local situation. Information systems in organizations are historically attached to practice as an integrated mechanism or medium within the performances of the professionals. Further I talked about how Information Technology sometimes is seen as a competent provider of universal knowledge, and how this, through so-called Knowledge Management initiatives, may threaten key mechanisms within the professional bureaucracy in bringing with it desires of detaching the knowledge from the knower. In the Information Society there is however a need to filter and structure information according to organizational needs. By aligning Information Technology flexibly with existing practices using it as a mediator between communicative and collective action, it can serve as a facilitator rather than a substitute, and as a

“friend” rather than an enemy. Although Internet has many positive aspects, the patients have to filter the information themselves. The need of patient information systems for lay people is thus obvious. Internet is however a medium where information formerly seen as secret can be accessed by lay people, this is a part of the consumer society.