**3. Research method**

#### **3.1 Empirical setting**

This study was conducted at a hospital in the western part of Sweden. The health care produced at this hospital consists of both acute and planned health-care services, divided in three different medical areas, each of which is further subdivided into smaller units; 17 in total. Acute and planned health care respectively, call for

#### *Operations Knowledge Management in Health Care DOI: http://dx.doi.org/10.5772/intechopen.93793*

suitable for such knowledge-intensive organizations as health-care organizations [28]. In order to effectively create sustainable operations performance in health care, developments in knowledge capability is important [18, 21]. KM adds value to operations performance in organizations concerning cost, quality, flexibility, and delivery. Thus, knowledge is a strategically significant resource. KM can be viewed from two perspectives: process and infrastructure [21, 29, 30]. The process perspective reflects the capability in an organization, but the process is based and dependent on the infrastructure. The infrastructure perspective defines the technology, structure, culture, and mechanisms that enable the configuration of resources and operational routines in the organizational processes [21].

*Operations Management - Emerging Trend in the Digital Era*

Technology has made it easier to transmit information in organizations, and is an important part of the infrastructure [18]. Many sophisticated information systems are used within health care, and they have a tremendous impact on the complex organizational context. Information systems also include different structures of their own. Information systems thus create structures for how people perform their work, and how they interact with the systems [20, 31]. By understanding the complex relationships between the health-care organization and the information systems that are used, it is possible to get a better understanding of how information systems can support OM and KM [32]. However, effective communication and a shared interpretation of the knowledge are critical for the performance

Three mechanisms for KM practice systems have been identified by Loon [33]; (1) learning and knowledge creation culture; (2) organizational architecture for adaptive and exaptive capacity; and (3) "business model" for knowledge capitalization and value capture. *Learning and knowledge creation culture* is based on culture theories, in which learning is seen as a set of values among a group of professionals, which underpin their behavior in creating knowledge. Those values are shaped by organizational structures. This mechanism influences the importance placed on formal and informal learning in the organization, and includes reward schemes, coaching programs and other formalized KM-specific roles and operations that strengthen the learning and knowledge creation culture. The *organizational knowledge architecture for adaptive and exaptive capacity* consists of the design of organizational systems, technologies, practices, skills, and behaviors, that for example facilitate sharing of knowledge. This mechanism shapes the orientation of technology use, to primarily codify knowledge or to use technologies to connect people to exchange tacit knowledge. Appropriate and relevant structures, technologies, and processes have to be developed to allow knowledge to be stored, transformed, and exapted to facilitate the performance of the organization. The *business model for knowledge capitalization and value capture* describes how an organization benefits from its KM practice system. This mechanism is directing how new knowledge is embedded in the organization's value proposition, as the organization has to be aware of how newly created knowledge will be characterized as useful and appro-

This study was conducted at a hospital in the western part of Sweden. The health care produced at this hospital consists of both acute and planned health-care services, divided in three different medical areas, each of which is further subdivided into smaller units; 17 in total. Acute and planned health care respectively, call for

of a health-care organization.

priate for its outcomes and defined goals.

**3. Research method**

**3.1 Empirical setting**

**254**

different planning methods. The patients' paths through the different health-care departments of the hospital is also planned and controlled, regardless of whether the health care is of an acute or planned character. The possibility for booking each patient is set by the detailed planning in each health-care department. To achieve a patient path that is as smooth and effective as possible, coordination of plans between different departments is often needed.

The mission, orders, and economical frames of Swedish hospitals are decided by the political governance. A document called "the health-care agreement" prescribes the overall assignments for the hospitals. This framework has to be transformed into terms that are useful for the planning and control processes within the hospitals, and communicated to the hospitals [20]. The admission of patients is also an important aspect that determines the need for resources and capacity. Moreover, there are databases of waiting lists with different patient groups, and different economical efforts at regional and national levels that affect the production of health care at the hospitals. Other regional health-care organizations, as well as the home health care conducted in the municipalities, also affect the production of health care at the hospitals.

At the studied hospital, the planning and control process generates forecasts, production plans, capacity plans, etc. The forecasts and plans aim to balance the needs for care within the frames given by the political governance. The different plans are then broken down through the organization, into more details regarding time horizons, care services, and resources at each department and service unit [20].

The processes of creating production plans differ to some extent between different levels in the organization. The collection of data and the elaboration of plans are performed by staff members with different positions in the organization. At the operations level, nurses often collect the data, create the plans, and book the patients. At the clinical department level, the manager and the production controller create the production plans. The plans cover one financial year and are adopted at the clinics board meetings once per year. At the hospital level, the production controllers from the different hospital departments together with the hospital's chief economic controller are responsible for creating the plans. The plans are adopted at the hospital board meeting once per year. The follow-up is normally done routinely each month, both at the levels of departments and hospital. Different actions are then taken when there are deviations from the defined production plans.
