KNOWLEDGE MANAGEMENT

Knowledge Management

Attn: CEO of the Regional Health Authority

Date: 27th Feb. 2010

Sub: Recommendations To The Regional Health Service About How Knowledge Management

Dear Sir

I would like to take the opportunity to inform you about the importance and the role of Knowledge Management in Regional Health Services. The Secretary of State for Health, supported by the Department for Health, is accountable to Parliament for the overall running of the NHS in England.

The NHS has recently embarked on a long-term programme of reform to devolve power and responsibility to the frontline (DoH, 2002a). The main feature has been to give locally-based Primary Care Trusts (PCTs) the role of commissioning hospital and community services. This has also meant creating new Strategic Health Authorities to hold PCTs and NHS Trusts to account, support performance improvement and help Trusts deliver NHS initiatives. This policy of “shifting the balance of power” (DoH, 2002a) created a new system of planning, management and performance assessment that included the possibility of high performing hospitals achieving NHS Foundation Trust status. With this status, comes more money and the reduction of central controls (earned autonomy). In contrast, under-performing organizations face the possibility of franchising. The objective is to create a dynamic system where responsibilities and roles increasingly gravitate to those best able to deliver them (DoH, 2004a). In line with Shifting the Balance of Power, the Department of Health is trying to tackle bureaucracy (DoH, 2002b. 2004b).

Within bureaucratic organizations there is high specialisation, rigid departmentalisation, high formalisation, centralised authority and decision-making generally follows the chain of command. The advantages of this type of structure are stability, conformity and control; the disadvantages are inflexibility, poor communication, and lack of cooperation between departments and different levels in the organization (Cowling and Mailer, 1998). Some of the measures introduced by the Department of Health to tackle bureaucracy are: new controls on information; redesign of planning systems; greater operational flexibility; staff involvement in policy development; simplification of funding processes; and review of “Arms Length Bodies” (DoH, 2002b, 2004b).

The bureaucracy is associated with a role culture, described as such because the role, or job description, is more important than the person who fills it (Handy, 1999). Position in the hierarchy is said to be the main source of power in this culture, and rules and procedures the main methods of influence. In contrast, organic structures are said to rely on more personal bases of power based on respect and expertise. This theory was tested by Atwater (1995) and the types of leader power that were most explicit were found to differ as a function of organizational characteristics. Expert power was greater in organizations with less status stratification. Contrary to expectation, power did not differ as a function of specialisation. With respect to formalisation, first-line supervisors were seen as having more referent power, as well as position power, in the eyes of subordinates.

This suggests that some position power may promote referent power and is an argument for NHS organizations to devolve more authority ...