IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
A case study of implementing knowledge
Management system in healthcare in Malaysia
Ehsan Borousan1 University, Cyberjaya, 63000, Malaysia (Email:
1
Faculty of management, Multimedia hanisamimi@yahoo.com)
University, Cyberjaya, 63000, Malaysia
(Ehsan_boroosan@yahoo.com) Zeinab Seyed Saleki4
4
Faculty of management, Multimedia
Mohammad Mehrdadi2 University, Cyberjaya, 63000, Malaysia (Email:
2
Faculty of creativity multimedia, Multimedia sana_saleky@yahoo.com)
University, Cyberjaya, 63000, Malaysia
(Mehrdadi.km@gmail.com) Mahmoud Manafi5
5
Faculty of management, Multimedia University,
Hani Samimi Sabet3
3 Cyberjaya, 63000, Malaysia
Faculty of management, Multimedia
(Email:Mahmoud_manafi@yahoo.com)
Abstract-Today Health Information Technology (HIT) is interesting topic in the recent years. Using knowledge
one of the key tools in improving health care efficiency, management in hospitals can improve the
quality and service. In between, the use of knowledge performance, knowledge and the skills of the
management systems in HIT has become one of the personnel, which leads to the overall improvement of
popular current trends, as an instance hospitals use
knowledge management systems to enhance the
the service. Although using knowledge management
employee performance, skills and consequently better system in hospitals is beneficial, there are different
service. Although knowledge management systems are barriers in implementing KMS in such environment.
proved to be beneficial, their implication in HIT sector This case study takes a look at the benefits of
is not easy. This case study tries to find the benefits of implementing KMS in a hospital setting, through the
using KMS in hospital settings. The research survey of 235 users. It also highlights the potential
framework is designed for KMS applications in a difficulties in implementing KMS project in
knowledge circulation process. We used a questionnaire Malaysia. The findings of this study are highly
survey and arranged an expert panel to solicit opinions beneficial for healthcare centers and in particular
from 235 users of a medical center in Malaysia. The
findings of research showed overall positive attitude
hospitals that are willing to install KMS in their
and benefit perceived by KMS users in the hospital. facilities.
Several major issues affecting the implementation of a
KMS system were identified including “perceived 2. LITERATURE REVIEW
usefulness”,” perceived ease of use”, “incentives for
KMS users”, “concerns of data security and 2.1 Knowledge management (KM) and Knowledge
confidentiality” and “organizational support”. By management system (KMS)
knowing these issues, the hospitals can solve the Studies show that Knowledge management (KM) is a
common problems of using knowledge management key factor in gaining competitive advantage
system in their operations and instead benefit from its
positive impacts.
(Holsapple and Singh, 2001; Ndlela and Toie, 2001;
Keywords: knowledge management system (KMS), Davenprot and Prusak, 1998). Knowledge has
Healthcare, Hospital different meanings. For example, Gray and Meister
(2006) defined knowledge as a mix of expertise,
experience, process, conceptual information and
1. INTRODUCTION insights that provides a framework for decision-
making or problem solving. Alavi and Leidner (2001)
Nowadays, Health Information technology (HIT) is a defined knowledge as “state of mind”, “object”,
common tool in enhancing medical and health care “process”, and “access to information “and”
services (Thompson & Brailer, 2004; Adler-Milstein, capability from diverse perspectives.
et al., 2007). In particular, the use of knowledge Knowledge management is the process of capturing,
management system in HIT has become an storing, sharing and using knowledge (Lee, 2001).
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IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
There are two types of knowledge; tacit and explicit. by KMS in our study.
Knowledge can change from tacit to explicit and vice KMS have various benefits for firms such as better
versa through knowledge conversion in a “knowledge communication, and improved knowledge sharing
flow” cycle, socialization, internalization, (Walsham, 2001). Knowledge system is firms can
externalization, and combination (Nonaka and also simplify the obstacles and improve the overall
Takeuchi, 1995). efficiency of the organization. In addition, KMS
In fact, knowledge management is the managing of plays an important role in improving management
the environment that knowledge flows into it and performance (Lee, et al., 2005). In other words,
changes. The role of Information technology (IT) in employees can remove the obstacles by finding the
knowledge management is critical. Nowadays, the necessary information and knowledge about the
role of the new forms of technology such as the issue, through integrated knowledge from various
Internet, intranet, extranet, and the new concepts of sources (Walsh & Ungson, 1991). Lee et al. (2005)
IT such as data mining and data warehousing have also states that KCP application can be affected by
become unavoidable in the firms. Knowledge the organizational culture. In fact, the human
Management System (KMS) refers to a class of relationship, and processes of organizational duties
information systems used in managing organizational are forms of KCP, in which knowledge flows.
knowledge. Therefore, KMS is an information Despite all the positive impacts of KMS, it also can
system designed to support and improve the process bring barriers to the organization. for example,
of creating knowledge, storage of knowledge, Walsham (2001) indicates that information and
transefer and application of knowledge within an communication technology are not the answer to
organization (Alavi and Leidner, 2001). In other improved knowledge-sharing within and between
words, KMS can be used for sharing of knowledge, people and organizations. He also adds that IT and
transfer the knowledge, rewuest for knowledge, and communication technology do not replace the
long-term two-way constructive discussion and knowledge from one human heart to another, nor do
communication (Alavi and Leidner, 2001; He, et al., they remove the need for individual’s relationships,
2009). which normally cannot be developed and maintained
2.2 KMS applications and their benefits effectively solely through electronic media.
Lee et al. (2005) proposed that KM leads to Healthcare organizations are knowledge-intensive
knowledge circulation processes (KCP), which starts organizations (Fitchett, 1988). As an instance, a
from creation, goes to accumulation, sharing, doctor’s experience is based on his knowledge and
utilization and finally internalization of knowledge. how well he can gain access to structured and well-
The first stage of KCP is knowledge creation. developed knowledge networks (Verhoeven, 2002).
Knowledge creation is creating tacit and explicit In fact, hospitals and other medical centers try to use
knowledge through encouraging synergistic their experts’ knowledge not only for their patients,
interrelations of individuals from diverse but also among their employees to create an
background. Accumulation of knowledge means that integrated knowledge network that benefits all the
all the individuals in the system must have access to members (Johnson, 1998). In Malaysia,
the source of the knowledge. The third stage if implementation of KMS is highly recommended in
knowledge sharing. Knowledge sharing as its name the hospitals as a way to improve the decision
says is the diffusion of knowledge to improve the making of the doctors in terms of diagnosis and
work of the system and decision making processes. treatment of the patients (Chen, et al., 2011), and at
The next component of KCP is knowledge the same time, help administrators in the hospital
utilization, the utilization of knowledge can happen at accreditation and management. It is believed that
any level of the firm, from top to bottom. For healthcare organizations are able to enhance their
instance, a popular form on knowledge utilization is competences through creating, diffusing, and
using benchmarking and best practices in a firm to integrating medical knowledge effectively.
improve the performance (O’Dell & Grayson, 1998).
The fifth and last component is knowledge 3. METHODS
internalization. This stage occurs when employees
find relevant knowledge to their situation, and use it We used a range of methods to gather user’s benefits
to improve their outcome. Since KMS is designed of the KMS implementation, including the literature
specifically to support and enhance KM activities, we review, case study, and questionnaire survey. A
adopted these five KM activities (accumulation, systematic literature review was initially performed
sharing, utilization, internalization, and creation of to develop an analytic framework for the KMS
knowledge) in KCP as KMS applications and try to applications in the knowledge circulation process.
explore what aspects of KM activities are supported Next, a case study design was used to perform an
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IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
analysis of KMS benefits perceived in a hospital Five KM activities (creation, accumulation, sharing,
setting. utilization, and internalization of nowledge) in KCP
Furthermore, a questionnaire was conducted based on were selected and classified as KMS applications
a literature review and consultation with the experts. (Lee et al, 2005). Under each of these five KMS
The aim of this questionnaire survey was to obtain applications, several items were designed. A five-
KMS users’ opinions in regard of the benefits point Likert-type scale response format, which
perceived during the implementation phase in a ranged from 1 (Completely disagree) to 5 (Extremely
medical center. The details of our methods are agree), was provided. Low rating represents a low
described as follows. degree of benefits perceived when using KMS, and
vice versa.
3.1 Case study
(2). Knowledge accumulation
The fact that there was no long-term case of using
KMS in Malaysia healthcare, we used several To assess the benefits of KMS towards knowledge
empirical studies of implementation of such systems. accumulation, three items were selected. These three
Later, based on the first aim of this study, we items include “I can use KMS to store expertise or
summarized the positive and negative impact of KMS knowledge necessary for the tasks”, “Hospital can
in each case, as well as a linkage between KCP and summarize education results and store them in KMS
KM activities to create a clear view of KMS for employees’ reference”, and “Hospital is able to
application in Malaysian healthcare system. systematically administer knowledge necessary for
Furthermore, based on the recommendations of the the tasks and store in KMS for further usage”.
experts, a specific medical center in Kuala Lumpur Respondents were asked to measure the benefits
Malaysia was to obtain KMS implementation perceived in the knowledge accumulation phase
experiences. when using KMS in their hospital.
The selected medical center is a national hospital (3). Knowledge sharing
with 1,212 inpatient beds and 2,550 staff. It provided Two items were selected to measure the benefits of
service to 1.6 million population of Malaysia, and has KMS usage in knowledge sharing. These two items
over three thousands outpatients and emergency include “We share information and knowledge
cases every day. The hospitals objectives are as necessary for the tasks”, “We improve task efficiency
following: (1) offering excellent medical service to by sharing information and knowledge”. Respondents
the public; (2) offering clinical teaching and were asked to rate the benefits perceived in the
internship; (3) conducting medical research and knowledge sharing phase when using KMS in their
development; (4) assisting the development of local hospital.
medical units and institutions; (5) organizing medical (4). Knowledge utilization
programs and training for personnel To measure the benefits of using KMS in knowledge
utilization, two items were used; “Culture of
In 2009, the hospital top management decided to organization encourages knowledge sharing”, “Team
adopt KMS as a management tool to improve their work is promoted by utilizing organization-wide
document preparation for the hospital accreditation, information and knowledge”. Respondents were
and meanwhile to facilitate the KM applications asked to measure the benefits perceived in the
across departments. knowledge utilization phase when using KMS in their
hospital.
3.2 Questionnaire survey (5). Knowledge internalization
According to the aims of this study, we conducted a Three items were used to measure the benefit of
survey to better understand the perceived benefits of KMS application towards knowledge internalization.
KMS by hospital personnel. The data collection was These three items are “Employees are given
done in two stages. The first stage was focused on the educational opportunities to improve adaptability to
characteristics of KMS in a healthcare setting based new tasks”, “I can learn what is necessary for new
on the analytic framework of KCP (Lee et al., 2005), tasks”, “I can refer to best practices and apply them
such as users idea about its usefulness, and ease of to my tasks”. Respondents were asked to measure the
use. The second phase was aimed to evaluating the benefits perceived in the knowledge internalization
benefits of using KMS in a hospital. The phase when using KMS in their hospital.
questionnaire items were designed and specific study (6). Knowledge creation
questions in this questionnaire were included as One item was selected to measure the benefits of
follows: KMS usage in knowledge creation. This item is “I
(1). KMS applications can apply knowledge in KMS to perform my new
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IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
tasks without duplication efforts”. Respondents were returned the completed survey. The length of time to
asked to measure the benefits perceived in the complete questionnaire for each respondent was 20
knowledge creation phase when using KMS in their minutes on average. The response rate is 90.6% in
hospital. our survey.
3.3 Data collection 4. RESULTS
This study obtained the hospital KMS users via 4.1 Demographics of the respondents
questionnaire. In the first stage, a pilot test of the From the 212 valid responses, 84.43% of users is
questionnaire was performed in several sections of female, 15.57% is male. The age range of users is
the hospital. Prior to the actual survey, a KMS 46.23% on 41-50 years old, 28.03% on 31-40 years
application seminar was held in January 16, 2011, to old. 37.26% users work in administration
help respondents understand the goals and departments, 34.43% in nursing department. 64.15%
applications of the KMS project in the hospital. A users have worked over 10 years, 16.03% users less
briefing of the KMS project was provided with the than 3 years. 26.04% users are using KMS more than
questionnaire to study participants. Finally, 235 5 times per week, 31.13% users less than 2 times per
participants who were involved with KMS week. The demographics of the respondents are
implementation were invited from across departments shown in Table 1.
such as administration, nursing, medical technology,
and clinical departments. Of these, 212 KMS users
Table 1 Demographics of the respondents
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IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
4.2 Data analysis of perceived benefits by KMS users
Based on the survey findings, KMS can help and knowledge” item. In the knowledge utilization
hospitals to improve the five stages of KCP, phase, 97.64% of users agrees “There exists a culture
accumulation, sharing, utilization, internalization and encouraging knowledge sharing” item. 95.28% of
creation of knowledge not only inside the hospital, users agrees “Team work is promoted by utilizing
but also among the different hospitals. In the organization-wide information and knowledge” item.
knowledge accumulation phase, 95.29% of users In the knowledge internalization phase, 96.7% of
agrees (including moderately agree, agree, extremely users agrees “Employees are given educational
agree) “I can use KMS to store expertise or opportunities to improve adaptability to new tasks”
knowledge necessary for the tasks” item. 97.51% of item. 94.34% of users agrees “I can learn what is
users agrees “Hospital can summarize education necessary for new tasks” item. 95.29% of users
results and store them in KMS for employees’ agrees “I can refer to best practices and apply them to
reference” item. 97.64% of users agree “Hospital is my tasks” item. In the knowledge creation phase,
able to systematically administer knowledge 95.28% of users agrees “I can apply knowledge in
necessary for the tasks and store in KMS for further KMS to perform my new tasks without duplication
usage” item. efforts” item.
In the knowledge sharing phase, 96.22% of users Table 2 shows the statistics of KMS benefits
agrees “We share information and knowledge perceived by the users under the construct of KCP
necessary for the tasks” item. 93.4% of users agrees (accumulation, sharing, utilization, internalization
“We improve task efficiency by sharing information and creation of knowledge) in our survey
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IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
Table 2 Statistics of benefits perceived by KMS users
5. DISCUSSION future use in similar cases” in the knowledge
This section discussed the several perceived benefits accumulation phase. More than 97% of users agreed
of KMS indicated by KMS users in the survey. The that “hospital culture encourages knowledge sharing”
findings of the survey showed an overall 94% score, in the knowledge utilization phase.
which shows an overall positive attitude and From the knowledge internalization perspective, our
perception towards KMS by KMS users in hospital. study found that users can refer to best practices and
Especially, more than 97% of users agrees that apply them to their tasks. Employees are also given
“Hospital can summarize education results and store educational opportunities to improve adaptability to
them in KMS for employees’ reference”, “Hospital is new tasks. This shows the positive impact of the
able to store the necessary knowledge in the KMS for hospital managers on KMS use within the hospital. In
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IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
addition, by using knowledge management systems, and used it as a core ingredient in the knowledge
users can performs their tasks without need to do the creation and circulation among the employees and
same thing twice. Based on the findings of this study, entire organization. The perceived benefits by KMS
the selected hospital successfully implemented KMS users are shown in Figure 1 and figure 2.
Figure 1. KMS benefits perceived by users (1)
Figure2. KMS benefits perceived by users (2)
The findings of this case study supported the trend of framework designed in the study can be used as a
using KMS in the healthcare industry (Chen & basis for similar organizations to understand the
Hwang, 2011). The analytical KMS application importance of KMS in knowledge management
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IRACST- International Journal of Research in Management & Technology (IJRMT), ISSN: 2249-9563
Vol. 2, No. 5, October 2012
strategies and creating competitive advantage. Based length of the study. In case of medical sector, longer
on the findings of this study, KMS application in studies are required to examine the benefits of KMS
hospitals has several issues, such as usefulness, ease applications. Despite the limitations, hospital
of use, incentives for the users, and data security and managers still can use the findings of this study to
confidentiality. better understand the critical issues of KMS
This study had several limitations. The first limitation application and change the policies and procedures to
was the fact that all the respondents were KMS users. remove the obstacles in implementation of such
The understanding of KMS users of the perceived systems to be able to benefit from their strategic
benefit of such systems can be different of that of rest advantage in healthcare.
of the organization. The next limitation was the
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