EXPLORING KNOWLEDGE `STICKINESS` IN THE HEALTH CARE SETTING

1호 (2008년 1월)

From Knowledge at Wharton
 
While it may be somewhat of a primitive term, "stickiness" is quite a well-known label in academic research literature. So it must have some sophisticated double meaning, right? Well, not exactly.
 
To better understand what academes are getting at, conjure the unfortunate image of your shoe stuck to a piece of gum on the sidewalk, suggests Roopa Raman, a doctoral candidate at Emory University's Goizueta Business School. "The idea of 'sticky' would be 'difficult to move,"' explains Raman. "Researchers needed a word that would create an illustrative analogy in your head to explain what they're thinking when they are talking about challenges with knowledge transfer."
 
Raman has studied those challenges that impede the internal transfer of knowledge -- and thus stickiness -- intimately in the past few years as she works on her doctoral dissertation. That focus has most recently yielded "Exploring Stickiness in Knowledge Transfer Processes: The Case of Evidence-based Medicine," a working paper that Raman co-authored with Anandhi Bharadwaj, an associate professor of information systems and operations management at Goizueta.
 
The research explores the causes and consequences of stickiness during knowledge transfer processes in the health care context.
 
"Difficulties with knowledge transfer are very significant in the health care sector, particularly now, with widespread concerns about health care quality improvement," explains Raman.
 
Raman draws on in-depth case study evidence from her observations at a large, urban hospital to provide a deeper conceptualization of stickiness and how it can be overcome. This case study, in which she interviews and observes nurses, nutritionists, physicians, pharmacists and pharmacy technicians, incorporates evidence-based medicine, an emerging concept in health care, that involves the transfer of up-to-date medical and scientific knowledge in order to provide consistent, high quality patient care across different providers and contexts within the same hospital.
 
The hospital featured in Raman's research is currently incorporating evidence-based principles to improve the quality of its patient care. The authors' model shows a full start-to-finish depiction of how stickiness arises and then, once it arises, how the sticky knowledge transfer process unfolds, leading to varied consequences, which could be either good or bad. It also provides a detailed look at the conditions that lead to good versus bad consequences from stickiness in knowledge transfer processes and the role that technology could play in overcoming stickiness and its negative consequences.
 
The authors first present a process-based perspective on how stickiness arises in knowledge transfer. The paper helps illustrate this through the example of the patient medication administration process, which requires the involvement of several health care professionals in the hospital setting, including the doctor who writes the order, the unit secretary who processes the order, the pharmacist who fills it and the nurse who administers the medicine to the patient.
 
"You have this overall goal -- in this case, medication administration -- that you need to accomplish, but within this overall goal there are also sub-goals for which different people in the corresponding roles are responsible," notes Raman.
 
"When you introduce a new practice for accomplishing a certain sub-goal associated with this process, based on the latest scientific evidence, the new practice often introduces rippling changes in other interdependent sub-goals involving other roles. Often people in those other work roles may be reluctant to accommodate these changes because they don't see the value or they may think those changes are going to introduce new difficulties in their own work flow. That's when transferring the new practice becomes sticky: when that misalignment exists between interdependent parts of the same process or when that need for realignment is not accepted or is not convenient for people."
 
Raman and Bharadwaj recognize the potential for both positive and negative outcomes from stickiness in knowledge transfer. "What we're showing here is that when you encounter stickiness, you are really just encountering difficulty with the process of knowledge transfer," notes Raman.
 
"But as we know from experience, difficulty does not necessarily spell bad news. A sticky process can go either way; it can result in a positive outcome or a negative outcome, and our work shows when and how each can occur. We've hopefully provided a roadmap that people can use to manage that stickiness so that you can get more positive outcomes and overcome the negative outcomes."
 
By identifying how stickiness can be managed successfully, the authors note in the paper that they "identify opportunities for redeeming the maximum value possible once stickiness is encountered in the transfer process."
 
"Exploring Stickiness in Knowledge Transfer Processes" proposes a multi-pronged approach toward managing stickiness, attacking the problem at multiple points of intervention rather than the more typical single-pronged strategy featured in existing literature. The authors discuss how best to avoid stickiness, as well as how to deal with the conditions and processes that lead to negative outcomes from stickiness.
 
Information technology plays a key role in the authors' stickiness intervention strategy. In this context, IT becomes more than a database tool. Organizations can embed the structure of the new evidence-based practice within the clinical information systems that health care providers in the hospital are required to use for documenting their work relating to these practices.
 
The electronic documentation requirements thereby mirror the new knowledge-based practice that the organization aims to transfer, thus prompting the various players -- in this case doctors, nurses and other hospital staff -- to follow the new practice.
 
"The technology is therefore prompting you to document based on what you should now do, following the new evidence-based practice, and not on what you had been doing before," explains Raman. "So it creates a certain pressure that prevents people from continuing to do what they did before, just because they don't want to deal with the change. There has to be a strong reason for them to go out of their way and defy what the computer is asking them to enter."
 
As she proceeds with her research, Raman is looking at what would enable patient-care units in the hospital to adapt successfully to the changes that the technology is introducing.
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