By evaluating the core policies and strategies of the NHS in the United Kingdom one can evaluate if these are aligned to the knowledge management and customer knowledge management objectives in a learning organization. The discussion will first approach the theoretical bases for these concepts as well as how they relate to one another in such an environment. Thereafter, application of these concepts will be evaluated within the specific strategies and policies of the NHS to determine the extent to which they applicable in this environment. The strengths of the organization will become highly relevant considerations therefore enforcing the view that perhaps the suitability of these models may be dependent on the nature or type of organization and not necessarily the organization itself.
The rise of knowledge management and customer knowledge management is an evolution of recent business strategies to the mutual benefit of all involved parties. By examination of the practices of an organization as well as the theoretical expected outcomes for that organization one can see the efficacy of these two strategies. The chosen organization is the National Health Service of the United Kingdom (NHS). It was chosen based on a variety of factors, including the strong interaction that it presents between knowledge management and customer knowledge management, with both being integral parts of the objectives and strategies of the NHS. Furthermore, it is a useful comparator as there are many different facets and strategic initiatives that are constantly being introduced and revised within the organization. There is a tangible vision and a very broad customer base therefore making the explanation of these concepts by way of example relatively straight forward. It will be shown through application of these concepts to the intricacies of the NHS that there exists a strong motivation for the implementation of these strategies as it is mutually beneficial to all involved parties. Through a strong basis in customer knowledge management, one can also see that there is the possibility of a relationship between CKM and KM generally. The relationship between these two concepts can be clearly seen with the NHS and in having such a relationship, fosters an environment of a learning organization. It is clear that the NHS is a learning organization based on its commitment to KM and CKM, which shall be shown through discussion and analysis in due course.
A Knowledge-Based Economy
The birth of knowledge management generally as a dominant organizational construct can be seen as a direct by product of the shift of the developed economies of the world from manufacturing based to knowledge based. The essential difference that this presents is that in a knowledge based economy, knowledge is the tool used to produce economic benefits, as well as job creation. There is also a distinction to be drawn between a knowledge-based economy and a knowledge economy where the latter is based on the idea of knowledge as a product. These concepts are inextricably linked and one cannot understand the important of KM without understanding the aims and intricacies of the knowledge or knowledge-based economy. In the literature on the topic, there is an apparent conflation of knowledge and knowledge-based, however this conflation is not a relevant concern for the purposes of the current discussion, suffice to acknowledge however that there is such a distinction.
A by-product of this shift is the importance of a knowledge-worker – one who works with his head instead of his hands, producing ideas, concepts and knowledge (Drucker, 1966). This represents the formation of the learning organization or organizational innovation, which are undoubtedly related to the concept of KM (Hislop, 2005), although the exact nature of the relationship between learning and KM is not necessarily clear. These concepts represent the emphasis of learning in organizational structure, management and processes (Hislop, 2005). KM may however be distinguished from these concepts on the basis that KM focuses on learning as a strategy for business development and the encouragement of knowledge sharing. Many organizations have chosen to internalize their KM efforts as part of their business strategy or human resource management, therefore enforcing the commitment to KM (Addicott et al, 2006).
KM has two distinct objectives: to transform data into knowledge and to transform tacit knowledge into explicit knowledge. As the names suggest, tacit knowledge is something which an individual knows, however this is difficult to capture and articulate for the purposes of knowledge sharing, whereas explicit knowledge is easily captured, documented and shared (Hislop, 2005). With these objectives in mind there are two broad approached to KM, namely an objectivist and a subjective concept.
The objectivist point of view advocates that knowledge as a commodity exists independently of individuals and is free of individual objectivity (Hislop, 2005). This approach is codified in the sender/receiver model – which sees the sender codifying explicit knowledge into a textual form that can be easily understood by the reader. It is independent of any socio-cultural factors and there is a strong emphasis on technological knowledge repositories where this information is categorized and stored.
The contrasting approach is the practice-based or subjective approach to KM where there is a strong emphasis on tacit knowledge communication which identifies socio-cultural factors as being highly relevant and that tacit knowledge by nature is difficult to identify, articulate and communicate. It does not emphasize explicit knowledge in the way that the objectivist approach does and uses the relationship between tacit and explicit knowledge as a communication tool. Knowledge Managers therefore encourage the transformation of their employees from egotistical knowledge hoarders to altruistic knowledge sharers (Eisenhardt & Galunic, 2000).
Customer Knowledge Management
Customer Knowledge Management (CKM) is an extension of KM between companies and their customers, creating knowledge sharing platforms between the two. It creates mutual value appreciation and performance, and is considered to be a strong competitive skill making the customer an active receiver of information rather than reliant and passive in communication. CKM is a combination of KM generally and customer relationship management. It involves direct communication with the customers, which is the essential element of CKM.
The resident idea with CKM is that there is a shift from what the company knows about the customer, to what the customer knows. Therefore affording the opportunity to gain knowledge from customers. This is the defining characteristic of CKM distinct from customer relationship management or typical KM. The typical angle that one would view a customer in this way is: If we only knew what the customer knows (Gibbert et al, 2002). This envisages the emancipation of the customer and in doing so creates a joint value system. The NHS is a perfect example of this as there is a new drive towards customer knowledge and involvement. There has been a recent drive towards self-help for pharmacies and the NHS generally, providing a service of a symptom checker. This allows the customer to input their symptoms into a database and in a way self-diagnose. This is a very useful form of customer feedback and by being proactive about health conditions there is a simple goal of education achieved and therefore better efficiency in the organization through customer support.
The Propagandist Perspective of the Learning Organization
The learning organization as explained above has propagandists and skeptics, however the propagandists believe that the achievement of a learning organization is an achievable idea because it presents significant benefits for the employees and the customers. Defined by Pedler et al as “organization which facilitates the learning of all its members and consciously transforms itself and its context,” (1997, 3) a learning organization has the added benefit of being adaptable to the latest trends or demands of the market place. It is in a sense characterized b y having open communication systems and can be described as the anti-thesis of a bureaucratic work environment (Hislop, 2005). One can obviously see the importance of this model to an organization such as the NHS, where there is the threat of very sudden need and demand for change. Therefore to be able to communicate learned knowledge between the various branches of professional involved is a highly beneficial system to have implemented. These benefits of the learning organizations are also challenged on the basis that they assume a certain willingness from the people involved, i.e. the stakeholders (Argyris, 2008) which is in itself problematic as studies have shown that this kind of knowledge sharing can often be perceived as threatening in that it may emphasize criticism rather than learning objectives (Chowdhury, 2006). It is debatable whether this is a relevant consideration in an organization such as the NHS, because of the nature of the environment. With the commitment undertaken by healthcare professional being very serious in nature and the general attitude towards healthcare not being treated flippantly, one could argue that a learning organization structure is intrinsically linked to the nature of the work involved.
The first highly relevant consideration in the creation of a learning environment is strategy. With regards to the NHS, this can be seen to be done at both a KM and a CKM level. In development of a relevant strategy, one needs to consider the stakeholders in the organization. For the NHS, the two most important stakeholders are the patients (customer) and the healthcare practitioners (doctors, nurses, paramedics, etc). Importantly however there is a larger public framework which sees various levels of involvement by the government and the public. In developing a strategy for any issue, one must be clear on the value system that one is aiming to represent. The NHS is committed to the long-term goal of providing good healthcare to all persons regardless of wealth (NHS, 2012).
One aspect of the NHS that is particularly admirable is the commitment that they demonstrate to strategic development. One can see that there is a strong commitment to being a learning organization in the flexible approach that they take to strategy. The increasingly demanding challenges of people in general having to make time to visit healthcare professional has been noted by the NHS and therefore they are adapting new strategies on how to provide healthcare to people without having to physically engage with the patient/customer. These can be seen on the strong online presence that NHS has providing symptom checkers, interactive quizzes and health articles. By doing this, the NHS are promoting a kind of public awareness towards health care issues and in doing so, strongly engaging in CKM by creating this shared value system, being one that is committed to good quality healthcare. Furthermore, because the NHS is a kind of public entity there is a large spectrum for public participation.
Once a strategy has been realized, one can look to internal methods of promoting these strategic objectives. As noted above, the NHS has a strong online presence involving technological innovation which allows for widespread and effective information dissemination. A very useful byproduct of these strategic initiatives is that it promotes a system of accounting whereby stakeholders are responsible for themselves. In doing so, one promotes the idea that individuals are responsible for their own wellbeing. There is a clear link here between the aims of CKM and those of the NHS. By providing information and self diagnostic criteria, there is an empowerment that is revolving around customer participation. In doing so, the NHS is also receiving critical data which in turn will assist the institutional KM objectives. By assessing the information provided by the symptoms test, crucial information relating to current ‘trends’ in the market can be used to assess things like product demand, service delivery and service demand to ensure that there are the correct available services in relation to those demands.
With this there becomes a need for internal exchange between the partners in the NHS to allow the dissemination of the information gained through CKM, transforming it into KM procedures. Due to the nature of the NHS, one can see that knowledge sharing in this way would be highly beneficial. Due to the nature of medicine, most of what is learnt is based on prior experience of professionals in the industry, therefore it can be called an industry practice and fostering of a learning organization through KM in this way seems like an almost natural byproduct. There is some room for reward in this case as industry professionals may receive much notoriety based on their scientific contributions to the industry, particularly in the avenue of medical breakthrough of treatment courses. There is a potential for relatively serious repercussions in the case of a failed treatment and this in itself often serves as a kind of ‘human incentive’ to facilitate information dissemination.
One needs to have a functional structure in order to enable the departments and stakeholders to work together and interact within one another. With regards to CKM, it is clear that there is a high level of structural support facilitating working together of the various stakeholders of the organization. The allowance for virtual interaction that exists on the NHS website as well as pharmacy ‘hotlines’ where information can be given or gathered for the benefit of the customer and the business.
This becomes slightly more problematic when moving into the sphere of KM, however due to the public nature of the NHS, the involvement or interference by the various stakeholders with one another is fairly pronounced. There is a customer feedback report that is available to all persons to complain about the individual practices and this therefore ensures a certain quality of service. There are further annual, bi-annual and quarterly conferences held where healthcare professionals are encouraged to share knowledge based on their experiences. In this way, tacit knowledge can be seen to transgress into explicit knowledge through sharing for mutual benefit. This relates back to the idea of incentive as notoriety in this way is often sought after by many professionals. It is arguable that this in itself promotes the product-based structure of knowledge management as it accounts of socio-cultural indicators simply by the nature of the subjects involved. There is however despite this an element of explicit knowledge emphasis as the practice of medicine itself is an objective account of symptoms and applying those universally according to those characteristics.
Obviously it goes without saying that the success of any organization is highly dependant on the input of what Pedler refers to as boundary workers. These are the people on the fringes of the organization that are by and large responsible for the gathering of information from various sources. This has particular relevance to both KM and CKM in that the information gathered has equal importance to both. In the case of the NHS, as with any organization that is service based, there are a large number of these boundary workers to gather this information. This is evident in both patient records and the information gathered through the NHS website and questionnaires that are used. By doing so, this data can be analyzed into knowledge that can be shared through objective output sources. One can go so far as to see how the symptom checker on the NHS website is a culmination of these processes as it is using a database of obtained knowledge to assist and share with the customer.
Through gatherings of industry professionals through conferences and publication of medical journals and articles, it is clear to see that there is a commitment by the NHS to intercompany learning. Sharing of information in the way that the organization does promotes the sharing of knowledge through databases and external communication sources. One must bear in mind that the NHS comprises of the majority of the healthcare sector and therefore communication between professional in the industry has a broad reach and high value.
The very nature of the healthcare industry promotes it as a learning climate. The consequence of the ever evolving field of human care requires constant evolution and a very flexible attitude towards learning. One can see that this is present in the NHS with the process of continuous evolution of policies and commitments towards various illnesses. The policies are changing and growing constantly in response to relevant societal needs. This can be seen in the emphasis placed on pre-natal healthcare and family planning, as this has become a relevant social issue in the last decade. This can further be seen in the new Cancer Policy of the NHS which is aiming to strategize towards a new and more aggressive approach to cancer research and disease control. The nature of the profession also encourages sharing of information in a network of professionals. Therefore these strategic initiatives are generally a combination of both KM and CKM as the need is coming from both sides, professionally and from the public.
There is a strong commitment by the NHS to career development and betterment of their staff. This can be seen more in the lower academic fields of carers and case workers particularly, where there is large training incentive to learning opportunities. The NHS provides a working and learning scheme whereby an employee’s skills can be enhanced. From the perspective of CKM there is encouraged learning through website publication as well as a vast array of information that is available from healthcare facilities. There is generally a broad commitment to all facets of healthcare, including mental and reproductive health care systems.
Analysis of the practical and theoretical aspects of the NHS and how it relates of KM and CKM in a learning environment is crucial for any organization to move forward. As a result a number of factors become relevant. It is clear that in the practice of the NHS there is a clear transformation of tacit knowledge into explicit knowledge. At the level of KM, this takes the form of documentation of subjective considerations. In other words, this will be case studies and patient notes. By examining these, the professionals create explicit knowledge that is objectively transferable to other professionals in the industry. By doing so, one could argue that the practice based approach to KM is being supported, as there are socio-cultural factors at play. Furthermore, by providing information to other stakeholders through articles and training, one is taking account of various education levels for example, carers and case workers. This is done by providing a simpler version of a complex set of facts. In the realm of CKM, there is also transference of knowledge from professionals to the clients using information relayed by the clients themselves. In doing so there is a mutual value creation done by the professionals to the customers taking account of relevant socio-cultural indicators. By creating this database for public assess they are allowing the expropriation of a certain level of customer by allowing them to do it themselves. It is clear that this has great benefit for the professional in the industry as it may relieve resource and staffing constraint.
In doing so, there is a clear creation of a learning environment. Whilst it has been argued that this learning organization is an inherent characteristic of the professional environment of the healthcare industry, it can also be seen in the CKM objectives. It is clear that by empowering the customer with knowledge, there is a certain responsibility that is transferred to the customer. This in turn will have a knock-on effect for those customers as they will be able to self-diagnose in the future and this will pass to their network of people and so on. An example of this can be seen in a simple common cold. Through experience, individuals know the symptoms and treatment plan of the common cold, therefore they do not generally seek out professional assistance as they are able to manage it themselves. If this were the case with other ailments, the best course of action will be decided upon by the customer which has a mutually beneficial effect. Knowledge sharing in this way generally has a similar effect for healthcare professionals as it will also lead to experience based beneficial outcomes. An example would be through cancer treatment, experience has proven that a certain course of action is most beneficial, therefore this is the proven solution that will be used. The publication of this information in journals and circulars helps to manage the knowledge sharing ensuring the maintenance of a learning organization within the NHS.
Through analysis, the NHS clearly presents itself as a learning organization. There is a strong interaction between CKM and KM in the NHS because of the public nature of the organization. It is clear that it is committed to knowledge sharing for mutual benefit and therefore presents a strong case for the e-flow model of the learning company. There is a strong presence of internal and external influence in the learning and knowledge strategies and this is clear through the flexible nature that is shown by the policy initiatives of the NHS. The research initiatives of the NHS demonstrate a clear transference of tacit knowledge to explicit knowledge in a way that it is capable of being shared and transferred between the various stakeholders. In doing so, the NHS have in some ways combined KM and CKM aspects and goals of the organization therefore empowering the professional and the customers. The nature of the organization arguably makes this a relatively simple activity as there is an inherent need for reformation and a commitment to learning and sharing knowledge. At the lower levels however this becomes more important, however one could argue that this is mitigated through the strong involvement by the public and accountability methods that the NHS provides for the customer. The NHS is a very good example of effective implementation of KM and CKM concepts in a learning organization. It has been shown that through commitment by the NHS, appropriate levels of customer involvement and empowerment, and the correct approach by the industry professionals, it is possible to have a good relay of knowledge sharing and that there is a possibility of strong interaction between customer knowledge management and knowledge management at a professional or higher level. It seems that it is essential to have accountability methods in order to ensure efficacy, however one could argue that this is simply an essential of the new, modern, learning organization. On the other hand, one could also discuss whether the success of the NHS in implementation of these strategies leading to their existence as a learning organization is highly dependent on the nature of the work involved and the type of professionals, subsequently meaning that perhaps there is an argument to be made which will mean that the success of KM and CKM strategies in a learning organization is more dependent on the type of organization and not necessarily the strategies thereof.
Addicott, McGivern, Ferlie, 2006. ‘Networks, Organizational Learning and Knowledge Management: NHS Cancer Networks’ Public Money & Management, 26( 2), pp. 87-94
Chris Argyris, 2008. Harvard Business Review on Knowledge Management
Chowdhury, M., 2006. ‘Human Behavior In The Context of Training: An Overview Of The Role of Learning Theories as Applied to Training and Development’ Journal of Knowledge Management Practice, (7)2
Drucker, P., 1966. The Effective Executive New York: New York
Eisenhardt & Galunic, 2000. ‘Coevolving: at last, a way to make synergies work.’ Harvard Business Review Jan-Feb, 91-101.
Gibbert, Leibold & Probst, 2002. ‘Five styles of Customer Knowledge Management,
And how smart companies put them into action’
Hislop, D., 2005. Knowledge Management in Organisations Oxford: Oxford Universty Press
National Healthcare Service [online] [cited on 19 May 2012)] accessed on nhs.uk
Pedler, M., Burgoyne, J. and Boydell, T., 1997. The learning company: a strategy for sustainable development, 2nd edition, Maidenhead, Berks: McGraw-Hill
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