2.1 Overview of knowledge management in healthcare
KM is a systemic approach, according to Bocock et al. (2012), to ensure that health professionals have access to the latest expertise and can apply that knowledge to their work at all levels within the health system, internationally, regionally, and nationally, as well as at the frontlines.
In an area like the healthcare sector, it takes constant innovation and technical evolution to try and balance consumer needs and costs. Previous research conducted by Elliot in "Knowledge Management in Healthcare" (2000) reported that KM is an important instrument in today's emerging healthcare system. Hospitals trying to incorporate KM programs need to consider the human aspect of the operation (Guptill, 2013).
Mohajan, (2018), notes that medical errors are a big problem in determining the quality of healthcare and a threat when patients die. If the right person uses the right knowledge at the right time, errors are preventable. Medical errors arise from the under-use of healthcare information that is fundamental to decision-making by clinicians. . Clinical decisions are taken in a cyclical way in which the healthcare professional applies his/her expertise during each cycle to validate the previous hypothesis and meet constraints to get closer to the final decision, indicating that knowledge of healthcare is not a resource but a service . Mariana (2008) highlights the need to increase the quality of healthcare through the use of innovations focused on patient and team treatment. Knowledge management refers to all management activities required for successful knowledge formation, capture, distribution, and management, according to WHO (2006). Houngbo et al., (2017) describes management of information as,
“A set of principles, tools and practices that enable people to create knowledge, and to share, translate and apply what they know to create value and improve effectiveness.”
The main aims of knowledge management for WHO is to bridge the gaps in knowledge between countries and within them. Similarly, Bolarinwa, Salaudeen, & Akande, (2012) suggests that knowledge management concerns itself with the creation of information and knowledge-based systems and processes to encourage originality, imagination, intellect, and learning. Successful knowledge management depends on three major components, according to Bolarinwa, Salaudeen, & Akande, (2012):
- People: who create, share, and use knowledge, and who collectively comprise the organizational culture that nurtures and stimulates knowledge sharing;
- Processes: the methods and procedures to create; acquire organize, store, share, use and apply knowledge;
- Technology: the mechanisms that store and provide access to data, information, and knowledge created by people in various locations.
2.2 Knowledge management technology and its role in healthcare
Different studies are conducted to investigate the needs and role of knowledge management technology in healthcare. Bali & Dived, (2007) indicate that KM needs are a pre-requisite for the KM ecosystem for KM technologies such as infrastructure, Internet, intranet and extranet. When developing a fully functional KMS for the e-health market, this instrument is an important technique (Mariana, 2008). Technology allows gratification to take place in ways that were never possible before. A network-computing infrastructure will speed up the harnessing of intellectual capital. In order to help any distinct approach to knowledge management, technology has emerged. Document management systems expedite the collection and retrieval of records. Web-casts allow synchronous communication between experts, while asynchronous interaction is made possible by discussion groups. Learning management systems control the progress of an employee with continuous learning, while data storage mines strong SQL databases that organize and analyze highly structured knowledge (Sharma & Wickramasinghe, 2004).
Healthcare is evolving rapidly because of technological advances, from anaesthetics and antibiotics to magnetic resonance imaging scanners and radiotherapy, according to Schwartz (2014). Similarly, Gulavani & Kulkarni (2010) point to the role of healthcare technologies. Such innovations have had a huge effect on healthcare and health service delivery. A variety of healthcare services have been shown to enhance organizational and logistical efficiencies, clinical performance, documentation and knowledge flow in a hospital environment, from telemedicine to electronic health records. However, adoption and benefits have not been widely distributed and it has been difficult to consistently achieve success. In order to enhance the quality, expense, productivity and capability of healthcare services, it is therefore important to incorporate knowledge management technologies.
2.3 Knowledge management technology and Decision making in healthcare
According to Saleh (2014), decision-making is a processes by which, based on collected knowledge, an optimal solution is selected among alternatives. It should have a fair priority based on its weight in order to choose this alternative. There are two key approaches to decision making (Phillips-Wren, Hahn, & Forgionne, 2014); Multi-Criteria Decision Making (MCDM) and Decision Support System (DSS). In order to assign the alternatives weights, both require a collection of parameters to be used. Both the MCDM and DSS are capable of addressing complex issues in application
Effective decision-making needs the technology to be completely assisted by knowledge management. Simon (2016) examined "the relationship between knowledge management tools and decision-making by interprofessional healthcare teams." The study's results indicate that the decision-making process is assisted by knowledge management technology. However, to determine the correct form of information and knowledge management technology needed to properly support the decision-making process, it is necessary to consider the type of decision making being carried out. It is critical that the right information is readily accessible at the right time and is current in clinical decision making.
Moreover, understanding the requirements of decision-making processes is essential. Saleh, (2014) noted that in healthcare, the situation is scary because almost most decisions are made subjectively with no or little consideration for influential criteria. He identified, lack of policies and strategies, non-existence of standardization, lack of training, shortage of funding, no sufficient analysis of data and inadequate reliable information communication technology are the major challenges observed in implementing and using knowledge management technology for clinical decision making.
Barsky, (2019) discussed the effect of technology on decision-making. Technology has modified the way health decisions are made by increasing the number of possible alternatives for the decision-maker. The diffusion of required information for rational decisions has compelled the decider to relinquish some or all of his authority. To a great extent, this has occurred because specialized knowledge is increasingly for understanding the treatment effectiveness and untoward consequences of decisions involving complex health systems or treatment programs. On the other hand, the decision-making role has under certain conditions shifted from the decider (physician, administrator) to the object (patient, community) affected by that decision. Experience with a major technological innovation, like the artificial kidney, which has been subject to much science and development (Tancredi & Barsky, 2014)
Furthermore, medical technology has a significant influence on health care decision-making at the patient-physician relationship, community-healthcare organization, and social-national government levels, according to Barsky, (2019). Three processes characterize this effect, such as the dissemination of decision-making by raising the potential alternatives, the relinquishing of part of the position of decision-makers to those in the healthcare system, and the transfer of some of the decision-making process to the intent of that decision (patient or community).
2.4 Barriers to implementing knowledge management technology in healthcare
A detailed literature review was done to identify the barriers of implementing KM technology for supporting decision making in health sectors. Garrett et al. (2006) endorsed this concept and noted that developed countries are still struggling to handle information and face many challenges, such as lack of infrastructure, expense, and time and value analysis, lack of qualified labor, national policies, and health-related staff motivation. There is a shortage of appropriate technical skills linked to technology. Projects in the field of health technology lack the requisite budget for implementation. . The period of time needed for the proper implementation of a particular health technology is very long
Emdadulhaque, Ahsan, Rahman, & Islam, (2019) indicate that constraints to the implementation of technology in the hospital include low budget for Information Communication Technology, poor infrastructure in the maintenance of health services, unreliable electricity supply and insufficient human resource capacity. Emdadulhaque et al., (2019) stated further the major barrier to technology implementation is the failure of healthcare information systems (HISs) to interoperate in order to distribute information concerning different standards among the institutions in the healthcare sector.
According to Nzui, ( 2014), lack of institutional capacity and trained human resources that can disseminate knowledge quickly is a hindrance to the efficiency of KM. Employees create knowledge within the organization and a significant part of the organizational knowledge is saved in their minds, thus a small change in their task positions can impose a fundamental effect on organization performance (UN, 2008).
The above literature shows that many organizations fail in their attempts to effectively use and implement KM technology in the clinical processes within their organization. Thus, this paper explores factors affecting the implementation of KM technology with clinical processes for supporting decision making in Ethiopian health sector.