Knowledge management as a driver of performance in ambulatory healthcare – a systematic literature review through an intellectual capital lens
| Pages | 403-432 |
| Date | 01 October 2020 |
| Published date | 01 October 2020 |
| DOI | https://doi.org/10.1108/JIC-02-2020-0068 |
| Subject Matter | Information & knowledge management,Knowledge management,HR & organizational behaviour,Organizational structure/dynamics,Accounting & finance,Accounting/accountancy,Behavioural accounting |
| Author | Nina S. Pflugfelder |
Knowledge management as a driver
of performance in ambulatory
healthcare –a systematic literature
review through an intellectual
capital lens
Nina S. Pflugfelder
Chemnitz University of Technology, Chemnitz, Germany
Abstract
Purpose –The purpose of this study is to investigate how Knowledge Management (KM) and Intellectual
Capital (IC) can increase the organizational performance of ambulatory healthcare providers and how such
performance can be assessed.
Design/methodology/approach –Following the PRISMA guidelines, a structured review of peer-
reviewed English-speaking articles up to 31
st
December 2019 was conducted. A search of ACM Digital
Library, Cochrane Libr ary, DARE, EBSCOHost, Med line, ProQuest, PubMed , ScienceDirect, Scopu s and
Web of Science produced 8 ,391 results. All studi es that did not examine the i mpact of KM initiatives o n
organizational perf ormance in an ambulatory healthca re provider setting were eliminat ed. The final sample
of 31 studies was examine d regarding the design of the KM initi atives as well as the performance conc epts
and indicators emplo yed.
Findings –A range of KM tools and methods (Electronic Health Records, Clinical Decision Support, Health
InformationTechnology, Training, Communities of Practice) have been shown to improve healthcare processes
but evidence of an impact on outcomes remains mixed. Performance indicators focus on medical quality but
rarely capture economic or social performance. Indicators have been adapted from the medical field, but do not
adequately capture IC and KM-induced performance.
Originality/value –This review provides an overview of KM initiatives in ambulatory healthcare and
assesses the associated performance metrics through an IC lens. Thereby, it enables further research on the
interplay of IC, KM and performance in ambulatory care and points to several research gaps. It provides
managers with guidance for designing KM initiatives in their organizations
Keywords Performance, Healthcare, Literature review, Knowledge management, Intellectual capital,
Ambulatory
Paper type Research-article
1. Introduction
Healthcare is a knowledge-intense business. Thus, it is not surprising that the claim that
managing knowledge drives organizational performance has received ample support in this
industry (Evans et al., 2015;Popa and S
¸tefan, 2019). This claim is rooted in the knowledge-
based view (KBV) of the firm, which posits that a firm’s knowledge resources determine its
performance (Penrose, 1959;Barney, 1991;Grant, 2002). Two paradigms have emerged from
this theory: the first paradigm, Intellectual Capital (IC), is rooted in accounting research, in the
sense that it originally tried to explain differences between the market and book values of
companies by valuing their stocks of intangible assets (Edvinsson and Malone, 1997). IC is
composed of human capital, structural capital and relational capital. Human capital
comprises the “skills, qualifications and experience”of the employees (Paoloni et al., 2020,
Knowledge
management in
ambulatory
healthcare
403
Funding: No funding was provided specifically for this article.
Thank you to my supervisor, Prof. Peter Pawlowsky, for his guidance throughout this project and to
the anonymous reviewers for helping me produce the best version of this paper.
Received 29 February 2020
Revised 9 July 2020
20 August 2020
Accepted 26 August 2020
Journal of Intellectual Capital
Vol. 22 No. 2, 2021
pp. 403-432
© Emerald Publishing Limited
1469-1930
DOI 10.1108/JIC-02-2020-0068
The current issue and full text archive of this journal is available on Emerald Insight at:
https://www.emerald.com/insight/1469-1930.htm
p. 16). Structural capital is defined as the knowledge “embedded in organizational processes,
systems, databases, patents and IPs”(Kianto et al., 2014, p. 364). Relational capital designates
the firm’s relationships with external stakeholders (Inkinen, 2015).
The second paradigm, Knowledge Managemen t (KM), is rooted in the strategic
management literature and focuses on knowledge flows (Nonaka and Takeuchi, 1995). A
multidisciplinary community of researchers and practitioners from the fields of computer
sciences, (strategic) human resource management and a range of industries has investigated
enablers and methods for influencing these knowledge flows (Nicolini et al., 2008;Orzano
et al., 2008a).
Although the KM and IC paradigms originally developed independently, interest in
examining them jointly has been rising. Some authors interpret KM as the “dynamic”side of
IC, effectively merging both concepts (Kianto, 2007;Paoloni et al., 2020). Other authors see IC
and KM as conceptually distinct, yet complementary drivers of organizational performance
(Seleim and Khalil, 2011;Hsu and Sabherwal, 2012). As this research area is thriving,
there have been numerous calls for its expansion (Seleim and Khalil, 2011;Hsu and
Sabherwal, 2012).
Ambulatory healthcare is an ideal “test ground”for KM and IC theory. This knowledge-
intense, yet tightly regulated industry, provides a homogenous competitive environment
where KM excellence as opposed to external shocks is likely to determine performance. At the
same time, organizational complexity is low, pre cluding distortions to performance
measurement from within the organization. Finally, the high number of organizations in
this sector provides ample research opportunities.
While previous reviews have examined the role of IC as a driver of performance in
healthcare (Evans et al., 2015;Paoloni et al., 2020), reviews on KM-driven performance have
been rare. There have been some reviews examining the impact of one particular type of KM
technology on healthcare performance (Hunt et al., 1998;Forsvik et al., 2017), but none of them
take an overarching perspective across different KM tools. Some reviews include both
technological and human-centered KM approaches but they examine barriers, enablers
(Nicolini et al., 2008;Ayatollahi and Zeraatkar, 2020) and methods of KM (Karamitri et al.,
2017;Shahmoradi et al., 2017), rather than KM-induced performance. Even though there have
been numerous calls for research on KM-induced performance and indicators to measure it
(Nicolini et al., 2008;Ensslin et al., 2016), this topic has not yet been examined in ambulatory
healthcare.
Against this backdrop, this review seeks to answer the following questions:
(1) What KM initiatives have been used by ambulatory healthcare providers and how do
they influence Intellectual Capital?
(2) How has KM-induced performance been operationalized in ambulatory healthcare
and what impact of KM on performance has been observed?
(3) How suitable are the indicators used in the literature for further research on KM, IC
and performance in ambulatory healthcare settings?
This article contributes to the literature by narrowing the research gap around KM indicators
in healthcare. It also points out research gaps related to novel KM initiatives for ambulatory
healthcare as well as performance concepts suitable to this space. Furthermore, it provides
guidance for ambulatory healthcare managers who seek to enhance performance of their
organizations through KM.
Section 2 of this articlediscusses the research methods,including the search strategy (2.1),
qualityassessment strategy(2.2), inclusion and exclusioncriteria (2.3) as well as dataextraction
methods (2.4). Section 3 discusses thesearch results (3.1), outlines typesof KM initiatives and
JIC
22,2
404
To continue reading
Request your trial