**Abstract**

The aging population of the western world poses a medical challenge for the society of today and the future. The pressure on health care and its organization is increasing as the demand for health care is growing at the same time as the costs are continuously rising. There seems to be consensus regarding bottlenecks in healthcare production systems, and that knowledge is needed in order to increase insights about operational decisions. This chapter is based on a qualitative case study conducted at a hospital in western Sweden. Eleven CEOs together with their production controllers were interviewed. The chapter aims to analyze knowledge management mechanisms in the infrastructure of a health-care organization. The analysis shows how mechanisms have significant impacts on the knowledge management practice in the operations management. A learning and knowledge creation culture, together with an organizational architecture for adaptive and exaptive capacity, and a business model for knowledge capitalization could support the production of smooth and effective health care in society, which is of high quality.

**Keywords:** health care, knowledge management, operations management, capacity planning, health-care sector, hospital

#### **1. Introduction**

Management of health care has received attention over some years [1], and the interest in this topic has increased during the last years, both in practice and in the literature. The COVID-19 pandemic, especially, has brought immediate focus to the capacity of resources in health care and its processes that are required to provide efficient and effective health care. The aging population of the western world also poses a medical challenge for the society of today and the future [2, 3]. The pressure on health care and its organization is increasing as the demand for health care is growing at the same time as the costs are continuously rising [4]. In hospitals, which is the focus of this study, health-care professionals aim to provide health care of high quality using the limited resources available, even though community-based services could be involved in the provision of health care for the inhabitants in a society. As such, a hospital can be described as a "network of service units with finite capacity through which patients are flowing" [5].

Operations management (OM) refers to the planning and control of processes that transform inputs into outputs. The term also applies to management of health care where patients who have requested health care are diagnosed, referred to a further service, or cured [6]. Resources at the hospital have to be managed to transform inputs to outputs. It is challenging to manage the health-care processes in 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 timely and appropriate care can be provided [14].

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,

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 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].

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

and applying knowledge across various health-care services [21].

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

the demand and the available capacities [8, 10, 24].

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

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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 OM.

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 future research.
