**2. Literature review**

#### **2.1 Operations management in health-care organizations**

OM is an interdisciplinary field that often uses mathematical modeling, analytic methods, and statistics to create production and capacity plans for controlling and improving an organization's ability to reinforce rational and meaningful management decisions at all levels [7]. Historically, these models and methods have mainly been used in the manufacturing industry. Recently, however, such models and methods have begun to be widely applied in the public sector as well, not least in the health-care sector. Production and capacity planning processes involve

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

order to ensure an effective health care that uses the available resources efficiently [7]. Moreover, it is challenging to balance resources with fluctuating and uncertain demand as in health care [8]. There seems to be a consensus regarding bottlenecks in health-care production systems, and that knowledge is needed in order to increase insights about operational decisions [8]. There are, however, flaws in the understanding and management of the variations in demand and capacity [9]. Some studies claim that problems exist due to poor demand and capacity management practices [10, 11]. Even though the planning and management of health care has gained more interest during the last 20 years, both within research and practice, very few concrete steps have been take in order to improve the OM in health-care practice [1]. Appropriate knowledge about accessibility, demand, and capacity variations could improve patient processes [12] as well as planning and modeling processes [13]. Knowledge management (KM) in the health-care sector is intended to support the operation of planning, performance, and control of health care. Health-care systems need to be designed to achieve smooth flow of patients so that

Massaro et al. have identified a research gap regarding KM in the public sector [15], even though organizational and managerial knowledge processes in health care have been increasingly studied during the past 20 years [16, 17]. Fugate et al. [18] claim that effective communication and KM play key roles in OM and the improvement thereof. However, most of this literature has not affected the development and organizational goals in the health-care sector, even though health-care organizations have adopted KM strategies to a certain extent [16]. The main success factors that influence the implementation of KM in the health-care sector are considered to be the infrastructure capability (such as information technology, organizational culture, and organizational structure) as well as the performance evaluation and measurement [16]. Developing an appropriate KM infrastructure is considered crucial for the improvement of quality in the health-care sector [19]. Few studies have, to this date, explicitly addressed the specific mechanisms in the KM practice systems in the health-care sector that are related to the infrastructure at the organizational level. Therefore, this chapter contributes with a qualitative analysis of the KM mechanisms in the infrastructure of a health-care organization. The analysis shows how mechanisms have significant impacts on the KM practice in

The remainder of this chapter is structured as follows: Section 2 provides a literature review of the OM and KM in the health-care sector. Section 3 provides the empirical setting and describes the methods used for data collection and data analysis. Section 4 presents the results of the study, which are discussed in Section 5. Section 6 concludes the chapter, together with the suggestions of a few topics for

OM is an interdisciplinary field that often uses mathematical modeling, analytic methods, and statistics to create production and capacity plans for controlling and improving an organization's ability to reinforce rational and meaningful management decisions at all levels [7]. Historically, these models and methods have mainly been used in the manufacturing industry. Recently, however, such models and methods have begun to be widely applied in the public sector as well, not least in the

**2.1 Operations management in health-care organizations**

health-care sector. Production and capacity planning processes involve

timely and appropriate care can be provided [14].

*Operations Management - Emerging Trend in the Digital Era*

the OM.

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future research.

**2. Literature review**

communication and coordination of information between hierarchical and horizontal levels. Planning and control involve deciding in advance which activities to do, how to do the activities, who should do what, when activities should be done, and what capacities are needed. A variety of decisions related to the hospital health care have to be made based on medical resource and financial aspects [20]. Decisionmaking in production and capacity planning requires coordination and management of information and knowledge at different hierarchical levels and in different time frames. Thus, management of information and knowledge is also needed between various health-care services within a hospital, as well as between other health-care providers, at a horizontal level. Capability of KM adds value to operations performance and in effective use of knowledge through acquiring, sharing, and applying knowledge across various health-care services [21].

Within a health-care organization, there is need to balance the available capacity of various resources. The resources also need to be coordinated to manage different types of medical activities and treatments. Departments are also sharing resources, and the demand and availability is fluctuating and uncertain [8]. The resources and the available capacities need to be managed in order to match the demands. The goal is to deliver health care of high quality, using the limited resources available. Designing and organizing health-care processes implicates planning and controlling activities. The process of designing and organizing in turn also implies setting goals for the activities and planning and controlling the operations. Planning requires information and knowledge at different organizational levels. Planning and management in health care can, for example, refer to the planning of operating rooms, the need for nurses and scheduling patients [22]. Dexter [23], among others, has for example studied planning and scheduling of operating rooms. The management and planning of health care thus comprise dimensioning, planning, scheduling, monitoring, and controlling resources [7]. However, there is an apparent gap between the demand and the available capacities [8, 10, 24].

The efficiency of health-care processes is a result of planning and management at different managerial levels. Developing effective plans for using resources and capacities requires understanding and knowledge of the dynamics in the hospital system and the flow of patients through it [8]. The quality of decision-making in each department depends on the information available for planning and decisionmaking, also, in relation to other departments in the hospital system. Managers and professionals who are planning and making decisions need to have knowledge about many different aspects within the organization, even beyond departmental borders. Sub-optimization is also a threat against effective planning and management, as decisions are made within different departments. Hulshof et al. [7] found that higher efficiency can be achieved if decisions are made from a more integrated perspective. The integrated planning and management of health care also faces challenges as different departments can have different goals, and conflicts can exist between different goals. Complex relationships between decisions within different departments exist, and this complexity has been identified as the most significant hindrance to effective OM. Hulshof et al. [7] claim that models are still missing for the management of health-care processes, for example flows of patient between different departments. Therefore, models for OM and KM need to be created [22, 25], also for the infrastructure that should be the basis for the processes [16].

#### **2.2 Knowledge management in health-care organizations**

Knowledge-intensive and professional organizations as hospitals are complex in their nature and require attention to aspects relating to their complex dynamics [26, 27]. Traditional management and leadership models are no longer entirely

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].

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

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

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

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

A qualitative approach was used in this case study [34, 35]. The qualitative case study approach is a strategy often used in studies of the use of information systems and KM within organizations [36, 37]. The case study produces context-dependent knowledge and experience without any attempt to make generalizations based on the collected data [38]. The study focuses on the planning and control of the production and capacity within the hospital health care as the case. Since the study focuses on a specific work practice, it is of great importance to use a methodological strategy that is adapted for research of the applied nature of the empirical setting [39]. The approach was to interpret the social phenomena in order to show what is socially constructed by the health professionals in their natural work practice. Data were collected through qualitative interviews that focused on views and experiences expressed by people [37]. What types of managerial actions were performed within planning and control of hospital health care and how the work was conducted were of interest in this study. The data collection focused on

plans are then broken down through the organization, into more details regarding time horizons, care services, and resources at each department and

between different departments is often needed.

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

health care at the hospitals.

service unit [20].

plans.

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**3.2 Data collection**

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 of a health-care organization.

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 appropriate for its outcomes and defined goals.
