Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational Innovation within Taiwanese Teaching Hospitals

doi:10.4236/ib.2011.31005

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iBusiness, 2011, 3, 30-34

doi:10.4236/ib.2011.31005 Published Online March 2011 (http://www.SciRP.org/journal/ib)

Evidence-Based Investigation for Determining the

Characteristics of Knowledge Management on

Organizational Innovation within Taiwanese

Teaching Hospitals

Chien-Chang Yang1, Chen-Chung Ma2*, Yung-Yu Su3, Patricia Moulton4

1Far Eastern Memorial Hospital, Taipei, Taiwan; 2I-Shou University, Kaohsiung, Taiwan, China; 3Meiho Institute of Technology;

Meiho, PingTong, Taiwan, China; 4University of North Dakota, Grand Forks, USA.

Email: [email protected]

Received December 13th, 2010; revised January 15th, 2011; accepted January 17th, 2011.

ABSTRACT

Knowledge management models assist executives in generating and adopting sufficient information for managerial de-

cision-making. These mod els may have utility in health care systems. This stu dy examined knowledge manag ement and

innovation through the development of a culturally-appropriate instrument and collection of information from health

care providers at several Taiwan teaching hospitals. Results indicated that several dimensions of the knowledge man-

agement model are associated with innovation and sharing of information in the study hospitals.

Keywords: Component, Evidence-Based Investigation, Knowledge Management, Organizational Innovation

1. Introduction

In the knowledge-based economical age, entrepreneurs

who can master the information of evidence-based knowl-

edge management will enhance their competitive advan-

tage. This is especially important in order to ensure that

new products and/or processes are innovative [1].

Healthcare organizations are facing many challenges due

to the rapidly changing global healthcare system in the

21th century. These challenges include spiraling costs,

increasing demands for quality care, and patient safety

issues. Health care professions are knowledge-intensive

professions which place health care organizations in the

position to find ways to manage their information and

knowledge-bases more effectively [2].

There are various forms of knowledge: experiential (tacit),

literature-based (theoretical), and evidence-based (both im-

plicit and explicit). Experiential and literature-based knowl-

edge, provide direction for executives in problem-solving; the

process of scientific methodology can be applied to guide the

process in testing whether the direction generated from expe-

riential and literature-based knowledge is suitable for specific

circumstances. As healthcare management is based on the

process of scientific replication and verification of facts to

generate evidence-based knowledge (EBK) [3], the devel-

opment of theoretical knowledge could provide a framework

for guiding evidence-based knowledge [4]

Health care executives who apply knowledge management

(KM) techniques have utilized an objective method for col-

lecting sufficient information and for generating/estimating

the required supervision information for managerial deci-

sion-making within healthcare administration [5]. Evi-

dence-based decision-making is the focus of knowledge

management which “deals with critical issues of organiza-

tional adaptation, survival, and competence in a rapidly

changing environment [3].”

The KM process can not only positively affect organ-

izational innovation (OI) [6]; it has also been shown that

Taiwanese business with more KM show higher capability

in enhancing OI [1]. However, such evidenced-based in-

vestigation has not been conducted within the Taiwanese

healthcare delivery system, especially in relationship to

patient care issues and EBM in healthcare administration.

As a result, there are two aims of this study: 1) creating a

local culturally appropriate instrument for exploring the

relationship between KM and OI for EBM; 2) recognizing

the key factors of the affects of KM on OI within teaching

hospitals based on the feedback of health professionals .

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational 31

Innovation within Taiwanese Teaching Hospitals

2. Background and Conceptual Framework

There are a variety of different KM models in the litera-

ture. Gloet and Terziovski (2004) described KM proc-

esses as knowledge creation, knowledge transport,

knowledge storage, knowledge distribution, and knowl-

edge sharing [7]. Cui, Griffith, and Cavusgil (2005) in-

dicated that KM consists of three interrelated processes:

Knowledge Acquisition, Knowledge Conversion, and

Knowledge Application [8]. Sandars & Heller (2006)

explained KM is the generation of knowledge, storage of

knowledge, distribution of knowledge, and application of

knowledge [9]. In short, KM could be regarded as an

umbrella term for a variety of interlocking processes.

Effective knowledge management has been presented

as one of the methods for improving innovation; as a re-

sult, innovation could be defined as a new product or ser-

vice, a new production process technology or a new

structure or administrative system pertaining to organiza-

tional members [1]. For understanding and identifying

different types of innovation within organizations, such

issue had been discussed [10]. Accordingly, the classifi-

cation of innovations included technical innovation and

administrative innovation [1].

Based on literature review [6,9,11] and with the current

challenges in the healthcare industry, this study proposed

that the aspect of OI will be affected by KM directly in

health care settings. Accordingly, in order to recognize

the strength of relationship between the aspect of OI and

KM, a conceptual framework and a model with 10 hy-

potheses which was generated for achieving its study tar-

get was displayed in Figure 1.

H1: Knowledge acquires creation will affect manage-

ment innovation positively.

H2: Knowledge acquires creation will affect techno-

logical innovation positively.

H3: Knowledge circulation proliferation will affect

management innovation directly.

H4: Knowledge circulation proliferation will affect

technological innovation directly.

H5: Knowledge storage internalize will affect man-

agement innovation directly.

H6: Knowledge storage internalize will affect techno-

logical innovation directly.

H7: Knowledge application sharing will affect man-

agement innovation directly.

H8: Knowledge application sharing will affect tech-

nological innovation directly.

H9: Management innovation will influence techno-

logical innovation directly.

H10: Technological innovation will influence manage-

ment innovation directly.

Figure 1. Conceptual framework and model.

3. Method

This study used a cross-sectional research design utiliz-

ing a structured questionnaire containing 55 questions

with a likert-type scale from 1 (strongly disagree) to 5

(strongly agree) to recognize health professionals’ (phy-

sicians, nurses, and medical technologists) opinion of

KM and OI within teaching hospitals in Taiwan. The

questionnaire included questions along six dimensions of

knowledge management which are defined in Table 1.

In order to test the initial validity of this instrument, six

domain experts were invited to discuss and revised the

content of this instrument, in order to provide content va-

lidity. In addition, descriptive analysis was performed to

explain the characteristics of study samples; a reliability

analysis was used to explain internal consistency; and an

exploratory factor analysis was used to confirm the valid-

ity of research instrument. A one-way ANOVA was used

to recognize which factors of KM and OI were related to

demographic variables. All these statistical procedures

were performed by using SPSS 15.0 statistical software

package. In addition, path analysis was adopted to explore

the relationships between KM on OI (10 hypotheses) by

using AMOS 7.0 statistical software package.

4. Result

This study was conducted at 25 teaching hospitals in

Taiwan; participants were requested to fill out the survey

instrument anonymously. Of the 375 questionnaires that

were distributed, 228 (60.8%) were completed during 1st

to 21st October 2008. Table 2 includes detailed demo-

graphic information of participants.

The reliability analysis indicated that all of the dimen-

sions had good internal consistency (with a Cronbach’s

alpha of greater than 0.8 [12] (see Table 3).

An Exploratory Factor Analysis (EFA) was utilized to

examine the validity of this instrument. Questions were

determined to be valid (see Table 4) (Questions would

be deleted if the value of community is less than 0.4, the

value of Kaiser-Mayer-Olkin (KMO) is less than 0.70,

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational

Innovation within Taiwanese Teaching Hospitals

Table 1. Operational definition of each dimension in this study.

Aspect/ Dimen-

sion Definition

Questions

Knowledge Man-

agement

KM as respondents’ perception of acquire creation, circulation proliferation, storage internalize and

application sharing.

Acquire Creation It is tacit knowledge that the expertise is generated by experience whilst immersed in daily practice.

Circulation

Proliferation

It is defined that tacit knowledge distribution is aided by the transfer of experiences to new workers by

mentoring and coaching schemes and to established staff by regular opportunities to share their knowl-

edge.

Storage Internalize It is defined that tacit knowledge is stored in the brains of health care workers but may be made partly

accessible to others once it has been codified.

Application Shar-

ing

It is defined that sharing both explicit and tacit knowledge between individuals and applied to decision

making

Management In-

novation

It involves organizational structure and administrative process; such innovation is indirectly related to

the basic work activities of an organization and is more directly related to its management.

Technical Innova-

tion

It pertains to products, services, and production process technology; they are related to basic work ac-

tivities; could be concerned either product or process.

Table 2. Characteristics of participants.

Characteristic Sample Valid Percentage (%)

Male 49 21.5

Gender Female 179 78.5

<30 58 25.4

31 ~ 40 106 46.5

41 ~ 50 56 24.6

Age

>51 8 3.5

High school 3 1.3

Junior college 47 20.6

Bachelor 137 60.1

Education

Post-graduate 41 18.0

Physicians 39 17.1

Nurses 136 59.6

Position

Medical technologists 53 23.2

Table 3. Results of the reliability examination.

Dimensions Cronbach’s Alpha value Corrected Item-Total

Correlation Cronbach’s Alpha if item

Deleted Questions

Acquire Creation 0.87 0.52 ~ 0.71 0.84 ~ 0.86 7

Circulation Proliferation 0.90 0.60 ~ 0.75 0.87 ~ 0.88 7

Storage Internalize 0.86 0.61 ~ 0.70 0.82 ~ 0.84 5

Application Sharing 0.87 0.53 ~ 0.73 0.83 ~ 0.86 6

Management Innovation 0.94 0.67 ~ 0.81 0.92 ~ 0.94 12

Technological Innovation 0.93 0.64 ~ 0.74 0.91 ~ 0.92 13

Table 4. Results of the validity examination and one-way ANOVA analysis.

Validity analy sis

Dimensions Communities KMOBartlett’s test of

Sphericit Factor Loading Variance Explained

(%) Eigenvalues

A 0.402 ~ 0.645 0.83 0.000 0.634 ~ 0.808 55.60 3.89

B 0.492 ~ 0.687 0.88 0.000 0.701 ~ 0.829 60.45 4.23

C 0.625 ~ 0.682 0.84 0.000 0.747 ~ 0.826 63.73 3.19

D 0.432 ~ 0.689 0.86 0.000 0.657 ~ 0.830 59.98 3.60

E 0.498 ~ 0.725 0.94 0.000 0.706 ~ 0.852 61.33 7.36

F 0.467 ~ 0.624 0.89 0.000 0.683 ~ 0.790 53.53 6.96

One-way ANOVA

Gender Education Position

Dimensions F valus S ig F valus Sig F valus Sig

A 0.02 0.88 1.29 0.28 1.57 0.21

B 0.02 0.88 1.06 0.37 1.54 0.22

C 0.05 0.83 1.36 0.26 1.14 0.32

D 0.00 0.95 1.25 0.29 1,78 0.17

E 0.21 0.65 0.68 0.57 0.40 0.67

F 0.02 0.88 0.41 0.75 1.07 0.35

A: Acquire Creation; B: Circulation Proliferation ; C: Storage Internalize ; D: Application Sharing ; E: Management Innovation ; F:

Technological Innovation ; *Sig. at 0.05 level

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational 33

Innovation within Taiwanese Teaching Hospitals

and the value of Bartlett's Test is greater than 0.05)

[13-16]. Results of the one-way ANOVA (Table 4) in-

dicated that all dimensions of KM and OI were not sig-

nificantly associated with demographic variables (gender,

education, and position).

In this study, model fit of path analysis was evaluated

by examining the chi-square statistic, the chi-square to

degrees of freedom ratio, the comparative fit index (CFI)

[16]. Goodness of Fit (GFI), Adjusted Goodness of Fit

(AGFI) [17]. And the root-mean-square-error of ap-

proximation (RMSEA) [18]. Detailed examination of

each hypothesis (see Table 5) indicates a significant

positive association between circulation proliferation and

management innovation – then list the other significant

relationships (see Figure 2)

5. Discussion

Reliability and validity analysis indicated that the devel-

oped instrument was an appropriate tool that can be util-

ized for conducting studies of Taiwanese health profes-

sionals to determine the relationship between KM and OI

[1-19]. This study also indicated that Management Inno-

vation is significantly associated with Circulation Prolif-

eration and Application Sharing. Technical Innovation is

significantly associated with Circulation Proliferation,

Application Sharing and the overall concept of manage-

ment innovation. These results will be useful for health

care administration as they explore knowledge and deci-

sion-making models for keeping up with the rapidly

change of global healthcare system in the 21th century.

The path analysis relationships results indicate that

Management Innovation is a moderator variable between

Circulation Proliferation, Application Sharing, and

Technological Innovation. Management Innovation is

indirectly related to the basic work actives of an or-

Figure 2. Results of research hypotheses.

ganization while technological innovation is directly re-

lated to basic work activities. This finding is similar to

Damanpour’s study that demonstrated a “dual-core

model” of organizational innovation; high professional-

ism, low formalization, and low centralization facilitate

technical innovations [10]. In short, results of this indi-

rect relationship relates to a real-world situations within

Taiwanese hospitals because all activities within hospi-

tals are controlled by organizational structure and ad-

ministrative process. These results are similar to Su’s

finding indicating that a hospital’s net benefits will be

affected by its organizational behaviors in Taiwan [22].

6. Conclusions and Suggestion

Based on the results of reliability and validity examina-

tion, this study provided an appropriate instrument to

explore the causal relationships between KM and OI

within Taiwanese hospitals for further study in healthcare

industry. Moreover, the present study demonstrated that

KM was a factor which will affect OI directly based on

Table 5. The results of hypotheses examination.

Hypotheses Standardized regression coefficient Critical Ratio

(C. R.)

H1 -- --

H2 -- --

H3 0.407** 5.104

H4 0.202** 3.465

H5 -- --

H6 -- --

H7 0.360** 4.516

H8 0.298** 5.518

H9 0.469** 10.184

H10 -- --

R2 for Management Innovation was 0.537; R2 for Technical Innovation was 0.777

-- Rejected in revised model; ** Statistically significant (p< α=0.01)

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational

Innovation within Taiwanese Teaching Hospitals

healthcare professionals’ perspective in hospitals. The

findings of this study have implications for healthcare

administrators as they integrate knowledge management

and organizational models that will develop learning or-

ganizations which reinforce sharing and application of

knowledge throughout the hospitals.

Further research could identify whether this instrument

could be used in different hospital levels or hospitals

with different ownerships in Taiwan. In addition, further

research could include qualitative studies to determine

how hospitals are integrating knowledge management

models and what successes and barriers they are experi-

encing.

7. Acknowledgements

We thank all participants who cooperated and helped us

to fill out the research instrument in the sample hospitals.

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