**4.3 Business model for knowledge capitalization**

The middle managers normally follow up on the statistics on a monthly basis. This could, however, in some situations be changed. Especially, if changes have been made, follow-ups could be done more often. The departments follow up on both a daily and a weekly basis, especially the number of discharges. Three different IT systems are used to follow up. In the case of warnings, or if the staff recognizes bottlenecks, analyses of what is happening and follow-ups will be conducted. Of course, all follow-ups result in some learning, but the knowledge is not diffused and implemented in the organization in a predefined way. However, the analyses further guide how the capacity is dimensioned. People at all levels, from the political and management levels, to the staff level at the hospital, who all naturally want to contribute to developing and improving the health care, get support from the data that the IT systems provide. Especially, the internal work is much in focus, to avoid queuing of patients.

total budget for production of health care at each hospital. This dimensioning then affects whether patients need to be rejected or referred to another health-care provider, maybe to another health-care level, such as a primary health-care center.

For each of the three themes, the key results are presented in **Table 1**.

actions

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

resources

resources

of disease

• Desire to have performance data in real time to learn and take appropriate

• A fixed number of operating rooms based on availability determines the

• Coordinators from different departments meet to exchange knowledge

• Desire to have knowledge to match the staff schedule with the needs

• Many different IT systems are used in parallel and in different ways

• A fixed set of standardized test packages is sometimes used for each group

• Oral analyses at departments on a daily basis to learn and create knowledge

• Number of admissions in the care agreement, but each admission can vary

• Collaboration with other health-care providers is needed for frail elderly

• Professionals share knowledge about the status of patients at daily

• Brainstorming for improvements is conducted at department meetings

• Middle managers follow up on the statistics at least on a monthly basis • Department managers follow up on a daily and weekly basis • In the case of warnings, follow-ups and analyses are conducted • Analyses guide the dimensioning of capacity, especially to avoid queuing

• The number of admissions says very little about the resources needed • Unclear how to estimate resource use: based on number of admissions or

• One goal is to decrease the number of visits at the emergency department • Politicians use statistics to allocate money to different health-care areas

• Planning and following up part of the daily management • Ad hoc-based recognitions of changes can cause a reassessment of

• Historical numbers are used for the emergency department

• Knowledge of shortcomings could save a lot of resources

• No formally structured learning and knowledge creation

• Excel sheets are used for scheduling and planning • Manual routines that the staff have to be reminded of • Difficult to rely on manually registered data • Dimensioning of resources is needed for planned visits • Scheduling needs to be done by experienced staff

• Monitoring of inflow and outflow of in-patients

• An ordered amount of health care should be produced

• The total number of patients is decided at the regional level • Departments use statistics to improve their activities and processes

• Knowledge is not diffused in a predefined way

• Follow-ups on an occasionally basis • Analyses and follow-ups are not documented • No routines for documenting work performance

in number of days

patients

meetings

of patients

*The three themes analyzed in the study and the results.*

average admission time

• Staff adapts to changes in admission of patients

• A need to manage required resources better

about inflow and outflow

**4.4 Summary of results**

Learning and knowledge creation

Organizational architecture for adaptive and exaptive

Business model for knowledge capitalization

**Table 1.**

**261**

capacity

culture

The regional administration orders the amount of health care that should be produced at the hospital. The provision of health care is measured by the number of admission sessions rather than the number of admission days. This indicator does not say much about the resources needed and used, because each admission session can vary considerably in length. This indicator also makes it very difficult for the hospital managers to follow up on the situation, and it provides little information that is relevant for the dimensioning of resources and capacity. To make sure the admitted patients receive effective health care and improve the economic figures, it is important to plan the discharge already when the patients are admitted. Implicitly, this means that the hospital gains financially if the number of days per admission is low, and the number of readmissions increases instead. However, this also increases the risk for low quality of the health care. For example, a low degree of readmissions of frail elderly patients shows that the hospital has successfully transitioned the patients to other health-care providers close to patients' homes. It is unclear what measure to use to estimate resource use: number of admissions, or average admission time. This will in turn affect how long time the patients are admitted at the hospital, and the number of admissions says very little about the need for, and use of, resources.

A lot of work is dedicated to decreasing the number of visits at the emergency department. The work involves a lot of collaboration with the ambulance department, the primary health care, the municipality health care, the special department for frail elderly people, and the department for guidance of people via telephone. All those collaborative activities are believed to affect the inflow of patients in a positive way, so that fewer patients seek emergency health care at the hospital.

Information from the registered data is used by politicians and decision makers at the hospital. Politicians use the data to get knowledge about the health care in order to allocate money to different areas and specialties. The health-care departments use the data to get knowledge about their performance, in order to develop and improve the health-care activities and processes. Especially, readmissions of patient are followed up, in order to get knowledge about to what extent the transitions to other health-care providers are successful. At the moment, the departments follow up their performance once a week, and the politicians intend to follow up once a month.

The top managers at the hospital scan the statistics a few times per year. Once per year, they decide how many patients each department could take care of, for each group of disease. In that way, they choose how to distribute the health-care beds and other resources among different patient groups. The total number of patients who are considered in the dimensioning is decided at the regional level, as a total budget for production of health care at each hospital. This dimensioning then affects whether patients need to be rejected or referred to another health-care provider, maybe to another health-care level, such as a primary health-care center.
