Ignorance management in hospitals

Publication Date14 November 2016
Pages430-449
Date14 November 2016
DOIhttps://doi.org/10.1108/VJIKMS-08-2016-0046
AuthorMaximiliane Wilkesmann
SubjectInformation & knowledge management,Knowledge management,Knowledge management systems
Ignorance management
in hospitals
Maximiliane Wilkesmann
Faculty of Business, Economics and Social Sciences,
TU University of Dortmund, Dortmund, Germany
Abstract
Purpose – The purpose of this paper is to investigate how professionals, like doctors, deal with their
ignorance? Which strategies do they apply? How can the organization support activities that encourage
dealing with ignorance in a positive way? The paper shows how ignorance can be managed in
professional organizations like hospitals.
Design/methodology/approach – To explore this touchy subject, the research follows a sequential
mixed method design. The advantage of combining research methods is the opportunity to explore an
uninvestigated research eld. In the rst exploratory research sequence (empirical study 1) preliminary
questions were dened by means of 43 qualitative semi-structured interviews with hospital physicians
and literature analysis. The results of the qualitative content analysis also served as a starting point for
the development of a Germany-wide online-questionnaire survey with more than 2,500 physicians
(empirical study 2).
Findings – The results show that breaks, a lack of negative organizational constraints, collective
learning, positive role models and intrinsic motivation have the highest impact on ignorance sharing of
physicians in hospitals. In reverse, negative organizational constraints, distrust, a lack of intrinsic
motivation and omitting the implementation of evidence-based insights in terms of collective learning have
the highest impact on hiding ignorance. These ndings help to manage ignorance in a positive way.
Originality/value – Physicians all over the world have to deal with incomplete information and
ignorance in their daily work. Mostly, they have no time and/or resources to gather all relevant
information before they make a diagnosis or administer a therapy. It is quite evident that scientic
discourses on knowledge management and professions mostly emphasize the power of expertise and
knowledge, whereas research on ignorance is currently more or less neglected. This paper is one of the
rst attempts to overcome this research gap.
Keywords Knowledge, Professionalism, Expert, Ignorance
Paper type Research paper
Introduction
In their daily work, physicians all over the world have to deal with incomplete
information. Mostly, they have no time or resources to gather all relevant information
before they make a diagnosis or administer a therapy. Decisions under ignorance can
lead to errors, which result in further suffering and lengthier treatment periods. In the
worst case, errors result in death (Ungar, 2008, p. 301). The World Health Organization
The author thanks the interviewees and the participants of the online-survey for so generously
sharing their time and experiences. The author is also grateful for comments on previous drafts of
this paper by the anonymous reviewers, Eric Tsui and the members of the Hong Kong Knowledge
Management Society. The German Research Foundation (DFG) funded the study from 2011-2017
(reference numbers WI 3706/1-1, WI 3706/1-2).
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/2059-5891.htm
VJIKMS
46,4
430
Received 28 August 2016
Revised 16 September 2016
Accepted 18 September 2016
VINEJournal of Information and
KnowledgeManagement Systems
Vol.46 No. 4, 2016
pp.430-449
©Emerald Group Publishing Limited
2059-5891
DOI 10.1108/VJIKMS-08-2016-0046
stated in 2011 that high reliability organizations like aviation have a better safety
record, i.e. a lower chance to harm people (1:1.0 million) than health care (1:300).
Interestingly, knowledge is almost always a positive key differentiator for the
description of societal changes in the form of the knowledge society, knowledge
economy, knowledge management, professional organizations and professionalism.
Ignorance, the other side of the coin is more or less neglected in all these debates.
Therefore, this paper aims to investigate the following research questions:
RQ1. How does a highly professionalized occupational group like physicians deal
with ignorance?
RQ2. Which factors inuence hiding and sharing ignorance?
RQ3. How can ignorance in organizations be managed?
To answer these questions, a brief introduction to knowledge as a central trait of
professional organizations and medical professionalism will be given. Juxtaposed to
this, it can be pointed out that ignorance is a neglected trait in the discussion on
professional organizations and medical professionalism. Afterward, the strategies on
dealing with ignorance in the hospital context will be introduced, which are followed by
a short overview of inuencing factors on hiding and sharing ignorance. On the basis of
these theoretical considerations and a qualitative study with 43 physicians, six
hypotheses will be deduced. On the basis of two comprehensive online surveys with
surgeons and anesthetists who are actually working in German hospitals, the
inuencing factors of hiding and sharing ignorance within their wards will be analyzed.
Knowledge – the central trait of professions and professional
organizations
In accordance with Mintzberg (1979) we can say that hospitals as well as professional
service rms t the professional conguration. Professional organizations have in
common that they are horizontally organized, their work is complex and it must be
carried out by professionals. Professionalism is regarded as an outcome of knowledge,
which is acquired by higher education and work experience (Svensson, 2006, p. 580).
Although professions “vary in the robustness and the legitimacy of their claims to expertise
and in their status” (Suddaby et al., 2008, p. 990), and a growing body of literature stresses the
transformation of the professional governance to a de-professionalized managerial form of
governance in health care (Evetts, 2006,2011;O’Reilly and Reed, 2011;Thomas and Hewitt,
2011), the most important capital of these organizations remains still their experts’
knowledge. The operating core of organizations conforming to the professional
conguration (Mintzberg, 1979) consists, to a great extent, of professionals (e.g. physicians,
lawyers, consultants). Professional organizations focus upon the delivery of intangible,
customized services through highly trained professionals (Suddaby et al., 2008). To sum up,
the professional bureaucracy emphasizes the power of expertise.
In this sense, knowledge is a key aspect of professional organizations (Mintzberg,
1979;Suddaby et al., 2008) and professions as well (Freidson, 2001;Abbott, 1988).
Physicians’ privileges and status are justied by their membership in a professionalized
occupation, which includes an exclusive body of (medical) knowledge. Members of a
professionalized occupation manage by to have control over the terms, conditions and
content of their work (Currie and White, 2012). In conformity with Abbott (1988), one can
431
Ignorance
management

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