Orzano A John, McInerney Claire R, Tallia Alfred F, Scharf Davida, Crabtree Benjamin F
Department of Family Medicine, Research Division, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 1 World's Fair Drive, Somerset, New Brunswick, NJ, USA.
Health Care Manage Rev. 2008 Jan-Mar;33(1):21-8. doi: 10.1097/01.HMR.0000304489.65028.75.
Knowledge management (KM) is the process by which people in organizations find, share, and develop knowledge for action. KM affects performance by influencing work relationships to enhance learning and decision making.
To identify how family medicine practices exhibit KM.
A model and a template of KM concepts were derived from a comprehensive organizational literature review. Two higher and two lower performing family medicine practices were purposefully selected from existing comparative case studies based on prevention delivery rates and innovation. Interviews, fieldnotes of operations, and clinical encounters were coded independently using the template. Face-to-face discussions resolved coding differences.
All practices had processes and tools for finding, sharing, and developing knowledge; however, KM overall was limited despite implementation of expensive technologies like an electronic medical record. Where present, KM processes and tools were used by individuals but not integrated throughout the organization. Loss of information was prominent, and finding knowledge was underdeveloped. The use of technical tools and developing knowledge by reconfiguration and measurement were particularly limited. Socially related tools, such as face-to-face-communication for sharing and developing knowledge, were more developed. As in other organizations, tool use was tailored for specific outcomes and leveraged by other organizational capacities.
Differences in KM occur within family practices and between family practices and other organizations and may have implications for improving practice performance. Understanding interaction patterns of work relationships and KM may explain why costly technical or externally imposed "one size fits all" practice organizational interventions have had mixed results and limited sustainability.
知识管理（KM）是组织中的人员发现、共享和发展用于行动的知识的过程。知识管理通过影响工作关系以促进学习和决策来影响绩效。
确定家庭医疗实践如何展现知识管理。
知识管理概念的模型和模板源自全面的组织文献综述。基于预防服务提供率和创新，从现有的比较案例研究中有目的地选取了两家表现较好和两家表现较差的家庭医疗实践。访谈、运营实地记录和临床接触记录使用该模板进行独立编码。面对面讨论解决了编码差异。
所有实践都有用于发现、共享和发展知识的流程和工具；然而，尽管实施了诸如电子病历等昂贵技术，但总体知识管理仍然有限。在存在知识管理流程和工具的地方，它们由个人使用，但未在整个组织中整合。信息丢失很突出，知识发现也不完善。技术工具的使用以及通过重新配置和测量来发展知识尤其有限。与社交相关的工具，如用于共享和发展知识的面对面交流，则更为发达。与其他组织一样，工具的使用是针对特定结果量身定制的，并由其他组织能力加以利用。
知识管理在家庭医疗实践内部以及家庭医疗实践与其他组织之间存在差异，这可能对提高实践绩效具有影响。理解工作关系和知识管理的互动模式，可能解释为何昂贵的技术或外部强加的“一刀切”的实践组织干预措施效果不一且可持续性有限。
