Department of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff, UK.
Implement Sci. 2007 Dec 20;2:44. doi: 10.1186/1748-5908-2-44.
In health care, a well recognized gap exists between what we know should be done based on accumulated evidence and what we actually do in practice. A body of empirical literature shows organizations, like individuals, are difficult to change. In the business literature, knowledge management and transfer has become an established area of theory and practice, whilst in healthcare it is only starting to establish a firm footing. Knowledge has become a business resource, and knowledge management theorists and practitioners have examined how knowledge moves in organisations, how it is shared, and how the return on knowledge capital can be maximised to create competitive advantage. New models are being considered, and we wanted to explore the applicability of one of these conceptual models to the implementation of evidence-based practice in healthcare systems.
The application of a conceptual model called sticky knowledge, based on an integration of communication theory and knowledge transfer milestones, into a scenario of attempting knowledge transfer in primary care.
We describe Szulanski's model, the empirical work he conducted, and illustrate its potential applicability with a hypothetical healthcare example based on improving palliative care services. We follow a doctor through two different posts and analyse aspects of knowledge transfer in different primary care settings. The factors included in the sticky knowledge model include: causal ambiguity, unproven knowledge, motivation of source, credibility of source, recipient motivation, recipient absorptive capacity, recipient retentive capacity, barren organisational context, and arduous relationship between source and recipient. We found that we could apply all these factors to the difficulty of implementing new knowledge into practice in primary care settings.
Szulanski argues that knowledge factors play a greater role in the success or failure of a knowledge transfer than has been suspected, and we consider that this conjecture requires further empirical work in healthcare settings.
在医疗保健领域，我们基于已积累的证据所知道的应该做什么与我们在实践中实际所做的之间存在着明显的差距。大量的实证文献表明，组织和个人一样，都很难改变。在商业文献中，知识管理和转移已经成为一个成熟的理论和实践领域，而在医疗保健领域，它才刚刚开始站稳脚跟。知识已成为一种商业资源，知识管理理论家和实践者研究了知识在组织中的流动方式、如何共享知识以及如何最大限度地利用知识资本的回报来创造竞争优势。新的模式正在被考虑，我们想探索将其中一个概念模型应用于医疗保健系统中实施基于证据的实践的适用性。
将一个名为“粘性知识”的概念模型应用于初级保健中尝试知识转移的场景中，该模型基于对沟通理论和知识转移里程碑的整合。
我们描述了 Szulanski 的模型、他进行的实证工作，并通过基于改善姑息治疗服务的假设性医疗保健示例说明了其潜在适用性。我们跟随一位医生在两个不同的岗位上，分析了不同初级保健环境下的知识转移的各个方面。粘性知识模型中包含的因素包括：因果关系不明确、未经证实的知识、来源的动机、来源的可信度、接收者的动机、接收者的吸收能力、接收者的保留能力、贫瘠的组织环境以及来源和接收者之间艰难的关系。我们发现，我们可以将所有这些因素应用于在初级保健环境中实施新知识到实践的困难。
Szulanski 认为，在知识转移的成功或失败中，知识因素的作用比人们怀疑的要大，我们认为这一推测需要在医疗保健环境中进行进一步的实证研究。
