The Exploration on the Realization and Practice of Knowledge Management between Middle Level Managers and Basic Level Nurses—Based on the Example: the Nursing Department of One Hospital in the South of Taiwan

• Main Authors: Kuo-ching Ying, 應國慶
• Other Authors: Bih-shiaw Jaw
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/33267493700955491164

碩士 === 國立中山大學 === 醫務管理研究所 === 93 === Reviewing the whole development history of management and the era background, we can find that the theories and practices of management are always continuing changing and improving. In addition, each industry starts to promote and apply the theories and practices of management to the operation of its individual industry with the changes or evolvements of the all industries in the outside environment. With the coming of knowledge economy in the 21st century, here comes the birth of “knowledge management,” and it also becomes the focus of the active implementation in each industry and business enterprise. First, knowledge management is actively implemented in business enterprises, bringing great effects and positive influences just like what Peter Drucker said in 1965—“knowledge” is going to replace tangible assets such as machines, facilities, capital, materials, and labors, and becomes the most important key element of production in business enterprises. Besides, “knowledge workers” will also replace the traditional labors and become the most efficient instrument which brings great benefits to business enterprises. Likewise, a hospital itself is an organization, too. In fact, the medical staffs in hospitals such as physicians and nurses are right the knowledge workers who are able to drive knowledge management. Moreover, the implementation of knowledge management in healthcare organizations or hospitals is still in the beginning phase. For this reason, the study will explore the realization and practice of knowledge management between middle level managers and basic level nurses. With regard to the implementation of knowledge management, the study is going to explore the practices and comparisons between the middle level managers and the basic level nurses in terms of knowledge acquisition, knowledge creation, knowledge storage, knowledge spread, and knowledge application, and to explore the outcomes of the implementation of knowledge management between these two levels under the enabling factors of knowledge management. Through the analyses and comparisons of the interview cases, here are the results and findings of the study: 1. The knowledge that the middle level managers and basic level nurses mainly value is the professional knowledge and skills of nursing. Then the concepts of services and the access environment and safety of patients are also concerned. 2. With regard to the implementation of knowledge management, the middle level managers and the basic level nurses both think that there is no specific or fixed one person who is responsible for the implementation of knowledge management but all people who work together to implement knowledge management according to their individual responsibility and accountability; that is, knowledge management is achieved by the division of labor. 3. As to the process and enabling factors of knowledge management exerted by the middle level managers and the basic level nurses, here are the outcomes: (a) In terms of knowledge acquisition, for the basic level nurses in the units, the most sources of collected knowledge are from books, periodicals, magazines, and rarely theses; for the middle level managers, almost the same as the basic level nurses. However, there are still some differences. For example, the vice director in charge of academic affairs thinks e-mails are also one of the sources of collected knowledge; the other vice director in charge of clinical practices, the head nurses in the units are also one of the sources of collected knowledge. (b) In terms of knowledge creation, both the middle level managers and the basic level nurses think that there is the mechanism of rewards in the hospital, such as the points of reward money and the reward money for new ideas. Furthermore, there are the competition reward money for QCC projects and the reward money for research proposals as well. Nevertheless, there is no cooperation in research between the nursing units in the hospital and other outside institutes or organizations, but there is cooperation relationship between the hospital and the nursing schools. For instance, the hospital is open for the nursing practicum of nursing students. (c) In terms of knowledge storage, both the middle level managers and the basic level nurses think the knowledge stored in the nursing department and units is paper-oriented and documentation-oriented. The paper documentation is usually keyed in and saved in the Word files of computers. However, part of knowledge is possibly not presented through the paper documentation and not saved in so-called “knowledge base” but then stored in personal brain through the oral sharing. (d) In terms of knowledge spread, there is one difference in the priority of the same ways frequently used to spread knowledge between the middle level managers and the basic level nurses. For example, the basic level nurses think the priority of the frequent ways used to spread knowledge in the units is informally oral dialogs, ward-checking, ward or morning meetings, and educational on-the-job training; the middle level managers, the priority of the frequent ways used to spread knowledge is educational on-the-job training, ward or morning meetings, seminars or studying clubs, and ward-checking. The best mechanism of knowledge spread in the units, both the middle level managers and the basic level nurses think, is educational on-the-job training. Meanwhile, there are also the small library rooms as the mechanism of knowledge spread in the units, but the effect of the library rooms is not that ideal in the viewpoints of the basic level nurses. (e) In terms of knowledge application, both the middle level managers and the basic level nurses think that they can effectively use the knowledge base composed of documentation and paper to find the information they need in short time, and the QCC projects are conducive to the quality improvement. In addition, both of them also think the knowledge and skills learned from the on-the-job training for the whole hospital employees and for the unit nurses can be applied to daily work. (f) In terms of the enabling factors of knowledge management, both the middle level managers and the basic level nurses think that the nursing department and the units encourage knowledge sharing and mutual discussion among employees. More than half of the basic level nurses think that the head nurses in the units offer them enough encouragement and support; the two vice directors as the middle level managers, their director offers them enough encouragement and support. Meanwhile, the majority of the basic level nurses think the ideal environment of knowledge development and the ideal welfare system of compensation management will make them be more delighted to share their knowledge and skills. However, the middle level managers think the support from the director, good leadership and positive approvals will make them be more delighted to share knowledge and skills. Moreover, most of the basic level nurses agree that the head nurses in the units will consider offering different courses of training to different employees according to their needs. The two vice directors as the middle level managers also think that the nursing department will also considering offering different courses of training to different employees according to their needs. Finally, the study proposes four suggestions to the case hospital, such as (1) improving the installation and application of knowledge flat-top building, (2) reinforcing the motivation and incentive of the mechanism of rewards, (3) opening the training courses of upgrading information ability for the nurses, and (4) adding one specific worker who is only responsible for knowledge management.