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Managing Knowledge Management: Managing the Manifold of Epistemic Objectives in Professional Health Care Organizations
Abstract
This chapter explores how health care professionals engage in multiple knowledge management practices with diverse epistemic objectives that are mediated through diverse objects. The chapter identifies a huge repertoire of knowledge management activities that can be grouped into four sets of knowledge management practices, which are directed at distinct epistemic objectives and mediated by distinct epistemic objects: normative knowledge management, formative knowledge management, reflexive knowledge management and emotive knowledge management. The types of knowledge management practices stipulated in the typology are ‘ideal types’ and should be understood as over-determinate and overlapping. Knowledge management activities, then, are not fixed or given practices, but are, rather, constituted in the ongoing and situated practices of the participants.
... Such practices may include making decisions about how to produce and evaluate knowledge, how to distribute and circulate it across geographical, professional, and organizational boundaries, how to assess and apply it in new contexts, etc. The engagement in epistemic practices involves not only epistemic objectives but also a variety of epistemic objects in terms of tools and techniques produced and used to promote the epistemic objectives of specific practices (Lystbaek, 2018). Hence, symbolic and material configurations anchor knowledge not only in professional communities and organizational cultures but also in technological artifacts and infrastructures. ...
Traditionally, the relationship between engineering, social sciences, and the humanities (SSH) has often been, to varying degrees, fraught, imbalanced and/or non-existent. Engineering has oftentimes been guilty of envisaging SSH as either providing a ‘soft’ window dressing or counterbalance to ‘hard’ projects representing ‘real’ progress, or to be used to more effectively ‘communicate’, for example in overcoming public reticence around such projects. The stories, histories, (her)stories, myths, language, text, images, art, provocations and critical insights which emanate from and characterize SSH are in this (dulled and marginalized) context more likely to be conceived as mere frivolous pursuits to help fill and support leisure time or promote cultural pursuits. This, we argue, not just feeds into the disconnect between respective disciplinary approaches, but seriously and dangerously miscomprehends the value (and values) that SSH can and indeed must bring to the table, in particular when facing emerging and emergent contemporary interconnected challenges around (un)sustainability. SSH can also benefit from such authentic and pragmatic engagement with engineering and science, while highlighting the necessary and invaluable contribution it can make to society, and across our universities, in particular in facing contemporary meta-challenges. This chapter draws upon academics and practitioners from both sides of the house in an Irish university context, who have journeyed together upon such pathways. The terrain and nature of some of these journeys are described, including some of the inherent difficulties and challenges. We highlight the need for journeying together with ‘disciplinary humility’, as equal partners, if we hope to make authentic progress. Finally, some historic and contemporary examples of potential points of convergence are proposed.KeywordsTransdisciplinarityEngineering educationSocial sciencesSociologySustainability
This chapter presents a multi-contextual framework for engineering knowledge that serves to highlight how engineering knowledge is configured in diverse contexts. We argue that the insights from the sociology of knowledge research and design science research can help us understand the complexity of engineering knowledge production and the diversity of the makers and takers of engineering knowledge. We aim at looking beyond popular notions of evidence-based practice and knowledge transfer, which privilege academia as the main setting for knowledge production. This will, we argue, facilitate a more nuanced understanding of how engineering knowledge is formed and transformed as it is transferred between different contexts. We describe this as configuration and reconfiguration of engineering knowledge in particular contexts.KeywordsEngineering knowledgeEpistemic practicesKnowledge transferTransformationArtifactContextConfigurationReconfiguration
'The variety of approaches that claim to constitute practice-based research are several and varied. Silvia Gherardi cuts through the various approaches to address practice-based research as itself a practice in an invaluable guide for organization and management researchers. Written in a characteristically accessible style, this volume is an indispensable guide.' - Stewart Clegg, University of Technology Business School, Sydney, Australia.
Knowledge is a very seductive, but elusive concept. Following the wider debate about the emergence of the information age and the knowledge society, recent years have seen an explosion of writings about organizational knowledge from different disciplinary and theoretical perspectives. Yet, theoretical development has not always been accompanied by sound empirical research. Methodologies for studying knowledge as an empirical phenomenon are still lagging behind. This book aims to fill the gap between theory, method, and practice by developing a phenomenological approach to the study of knowing in the context of organizing. The book contributes to the fields of strategy and organization in three ways. First, it provides a critical review of the concepts, debates, and epistemological assumptions underpinning existing theories of organizational knowledge. Second, it develops a methodological framework for studying knowledge processes as an empirical phenomenon that is based on three methodological lenses: time, breakdowns, and narratives. Third, drawing on the three-lens framework, the book presents a phenomenological enquiry on knowing and organizing processes within two large car-manufacturing plants at Fiat Auto, Italy. The book highlights the need to re-think organizational knowledge from an action-based perspective, and suggests a new vocabulary for understanding knowledge-oriented phenomena in organizations.
"Once upon a time, several engineers, biologists and clinicians realized that a lot of information in biomedicine was partitioned into 'silos' that do not intercommunicate. These silos were a side effect of the existence of different disciplines required to, for example, develop new drugs. The engineers decided to dispose of the silos, and to put the information in axiomatic form to facilitate automatic reasoning over multiple data sources. They also decided to do this in a very open way so that effort was not duplicated. This seemed to be a very reasonable step and was welcomed by all. This article is protected by copyright. All rights reserved.
The so-called " linguistic turn" purportedly has allowed scholars to demonstrate why it seems so important to focus on language, discourse, and social interaction when studying organizational phenomena. However, it could be argued that it also led them to neglect some key aspects of the role material agency plays in organizational processes, a negligence that the more recent " material turn" could be said to be addressing. This chapter proposes to show, both theoretically and empirically, that analysts do not actually need to keep turning in one direction or another, that is, choose between materiality and discourse, so to speak, but that they should rather focus on the multiple ways by which various forms of reality (more or less material) come to do things and even express themselves in a given interaction.
Large numbers of organizations are taking great interest in the idea of knowledge management and many are launching knowledge management initiatives and programmes. A large proportion of such initiatives will fail. Yet, despite the injunctions to “learn from failure”, little detailed attention has been paid to why and how these apparently popular initiatives run into difficulties. The purpose of this article is to examine, in some unusual detail, a significant example of a failed knowledge management initiative in order to analyse what went wrong and to identify the key learning points.
Purpose
The aim of the paper is to explore how multiple modes of knowledge play out in the consolidation of nursing procedures in construction of “local universality”. The paper seeks to explore processes where nurses negotiate universal procedures that are to become local standards in a hospital.
Design/methodology/approach
The paper is based on a case study design. Working group sessions, where the activity was to consolidate different versions of nursing procedures were observed and videotaped. For this paper, transcribed videotaped observations, where tension‐laden situations were identified, are subject to interaction analysis.
Findings
In the negotiations to construct standards, multiple modes of knowledge play out; personal experience, collective expertise and formalized knowledge. The paper demonstrates the contributions these modes of knowledge make in a process of standardization. This shows that standards, as such, do not stay universal for very long, but are constructed as “local universalities”.
Research limitations/implications
The study elaborates on discursive negotiations of procedures to illustrate how local universality plays out in processes to constitute standards. It is a limitation because how the local universality plays out in clinical work, or make claims about practice transformation, cannot be described.
Originality/value
The paper shows the necessity of confronting standardized procedures through multiple modes of knowledge. The paper exemplifies productive interactions in the construction of local universality, and how professionals account for practice when facing formal and standardized procedures.
This paper addresses the challenges that arise when knowledge production occurs in cross-disciplinary settings. To date most studies on communities of practice have focused on knowledge production within communities of practice rather than across communities of practice. We analyse the various professional groups in a medical R&D department as a constellation of distinct, but interconnected communities of practice with different epistemic cultures. The medical R&D case is particularly interesting for this purpose, because it involved creating new cross-disciplinary practices between different pre-existing and well-established communities of practice. In line with our focus on the challenges and processes involved in cross-disciplinary knowledge production, we describe negotiations and tensions during the establishment of the department, as well as in day-to-day practice. In particular, we focus on how the ‘machineries of knowledge production’, that is, the actual mechanisms by which knowledge is pursued, are different across the various communities of practice. These machineries belong to different epistemic cultures on a national or even international scale, and thus every community of practice is part of a complex web of people, activities and material structures extending well beyond the immediate work context. This networked character of knowing in practice explain why learning on the system level of communities of practice can be challenging. It may lead to path-dependent learning processes, and radical change can become limited if the knowledge required by new and different practices is incompatible with the existing stock of knowledge. Consequently, we suggest that the communities of practice approach could be enriched by looking at diversity and discontinuity in the epistemic cultures and networks that the different communities of practice are associated with. Copyright © 2008 John Wiley & Sons, Ltd.
This paper aims to shift the unit of analysis in the study of organisational knowledge from individuals and their actions to practices and their relationships. It introduces the concept of "site" to help advance an understanding of the relationship between practice and knowing. The notion of site supports the intuition that knowing is both sustained in practice and manifests itself through practice. It also evokes the idea of knowledge as being rooted in an extended pattern of interconnected activities that only when taken in its living and pulsating entirety constitutes the site of knowing. In this paper, I review the different ways to conceptualise the relationships between knowing and practice, and I show how the idea of site adds to the existing body of work. Building on the results of a longitudinal study in the field of telemedicine, I then offer suggestions on aspects of practice where knowing manifests itself, and I use the concepts of "translation by contact" and "at distance" to explain how dispersed knowings are woven together and the power effect that can derive from these. I conclude by reflecting on the implications of this radical view and the direction for future research.
A critical approach to coaching & mentoring theory and practice including doctoral research data, case studies and theories/ perspectives on goals, creating a coaching culture, ethics, diversity, models & perspectives, international C & M, e- development in C & M
This study provides an overview of the knowledge management literature from 1980 through 2014. We employ bibliometric and text mining analyses on a sample of 500 most cited articles to examine the impact of factors such as number of authors, references, pages, and keywords on the number of citations that they received. We also investigate major trends in knowledge management literature including the contribution of different countries, variations across publication years, and identifying active research areas and major journal outlets. Our study serves as a resource for future studies by shedding light on how trends in knowledge management research have evolved over time and demonstrating the characteristics of the most cited articles in this literature. Specifically, our results reveal that the most cited articles are from United States and United Kingdom. The most prolific year in terms of the number of published articles is 2009 and in terms of the number of citations is 2012. We also found a positive relationship between the number of publications’ keywords, references, and pages and the number of citations that they have received. Finally, the Journal of Knowledge Management has the largest share in publishing the most cited articles in this field.
This book challenges the evidence-based practice movement to re-think its assumptions. Firmly rooted in real practice while drawing lucidly on a great breadth of theoretical frameworks, it examines afresh how clinicians use knowledge. Evidence-based practice has recently become a key part of the training of all health professionals. Yet despite its 'gold-standard' status, it is faltering because too much effort has gone into insisting on an idealised model of how clinicians ought to use the best evidence, while not enough has been done to understand why they so often don't. Practice-based Evidence for Healthcare is a groundbreaking attempt to redress that imbalance. Examining how clinicians actually develop and use clinical knowledge day-to-day, the authors conclude that they use 'mindlines'- internalised, collectively reinforced, tacit guidelines. Mindlines embody the composite and flexible knowledge that clinicians need in practice. They are built up during training and continually updated from a wide range of formal and informal sources. Before new evidence becomes part of practitioners' mindlines, it is transformed by their interactions with colleagues and patients via their communities of practice and networks of trusted colleagues. To explore how mindlines work Gabbay and le May draw on a wide range of disciplines to analyse their detailed observations of clinical practice in the UK and the US. Their conclusions and provocative recommendations will be of value to all practitioners, health service managers, policymakers, researchers, educators and students involved in the promotion of evidence-based practice.
Purpose
This paper seeks to present a theoretical framework with the aim of contributing to improved understanding of how reflection can provide a mechanism to integrate research‐based knowledge with the pre‐existing practice‐based knowledge.
Design/methodology/approach
The paper begins with an explanation of important concepts: research‐based and practice‐based knowledge, four levels of action and two modes of learning. Two mini cases concerning managers in the public sector in Sweden then provide an illustration of how research‐based knowledge can be utilized to challenge practice‐based knowledge. The concluding discussion addresses some of the challenges involved in achieving reflection in the workplace that utilizes research‐based knowledge.
Findings
The reflection programmes had several characteristics that facilitated their implementation: they achieved a balance between the workplace demands on the participating managers and time required for the reflection; the participants were specifically recruited, had full management support and were highly motivated to be part of the reflection groups; the facilitators played key roles in structuring the managers' discussions and linking their experiences to relevant research‐based knowledge.
Research limitations/implications
Methodological limitations of the cases constrain the conclusions to be drawn from these studies. However, it should be emphasized that the case studies were intended primarily as illustrations of how workplace reflection can be used to integrate research‐based and practice‐based knowledge. Obviously, there is a risk of social desirability bias because the interviewer was also involved in developing and implementing the reflection programmes. She also participated as a supervisor in mini case 2.
Originality/value
The literature on reflection has largely focused on reflection in the context of education, training and preparing for work or a profession. The role of workplace reflection and learning for practitioners and managers in work has received far less attention. The emergence of the evidence‐based practice (EBP) agenda has further highlighted the importance of workplace learning and reflection, as practitioners are increasingly expected to critically appraise research studies and integrate new findings into their practice. A more EBP requires reflecting practitioners who are able to synthesize research‐based knowledge with their own practice‐based knowledge acquired through experience. However, the process of integrating research‐based and practice‐based knowledge has not been the focus of much study.
This article addresses how knowing and practising unfolds in collaborative research amongst practitioners from a large consulting and business services group and academics from a UK School of Management. Dialogue enabled actors to cross between theory and practice by providing a ‘space’ for support, challenge, exchange and experimentation. However, this ‘space’ was fragile and the insensitive actions of one individual, driven by institutional pressure to exploit the project for competitive advantage, resulted in withdrawal and the re-establishment of traditional divisions. Our view is that collaborative research is not necessarily an exercise in producing, transferring and implementing research findings but is better thought of as knowledge integration through a dialogue of theory and practice. The article contributes to the ongoing debate about the relevance of management research and the theoretical development of knowledge co-production.
An organization’s capacity to share knowledge among its individuals and teams and apply that shared knowledge to perform important activities is increasingly perceived as a vital source of competitive advantage in many industries. This importance is reflected in the large number of organizations that have implemented formal approaches to knowledge management to influence the application of organizational knowledge over the last two decades. Extant theory argues that organizations must focus their efforts on either the codification or personalization approach to knowledge management and maintain this focus unless there is a contextual change within the organization. The empirical research in this paper, based on 42 interviews across 5 management consultancies, found that the consultancies implemented multiple approaches to address specific knowledge-related objectives, conflicting with the prediction of extant theory. These consultancies also changed their approach to knowledge management for both contextual and learning-based reasons. Building on these findings, a pluralistic model of knowledge management is developed that balances the strengths and weaknesses of knowledge management approaches to deliver an integrated solution.
This article works out the main characteristics of `practice theory', a type of social theory which has been sketched by such authors as Bourdieu, Giddens, Taylor, late Foucault and others. Practice theory is presented as a conceptual alternative to other forms of social and cultural theory, above all to culturalist mentalism, textualism and intersubjectivism. The article shows how practice theory and the three other cultural-theoretical vocabularies differ in their localization of the social and in their conceptualization of the body, mind, things, knowledge, discourse, structure/process and the agent.
The organizational problem firms face is the utilization of knowledge which is not, and cannot be, known by a single agent. Even more importantly, no single agent can fully specify in advance what kind of practical knowledge is going to be relevant, when and where. Firms, therefore, are distributed knowledge systems in a strong sense: they are decentered systems, lacking an overseeing ‘mind’. The knowledge they need to draw upon is inherently indeterminate and continually emerging; it is not self-contained. Individuals' stock of knowledge consists of (a) role-related normative expectations; (b) dispositions, which have been formed in the course of past socializations; and (c) local knowledge of particular circumstances of time and place. A firm has greater-or-lesser control over normative expectations, but very limited control over the other two. At any point in time, a firm's knowledge is the indeterminate outcome of individuals attempting to manage the inevitable tensions between normative expectations, dispositions, and local contexts.
In this essay, I begin with the premise that everyday organizing is inextricably bound up with materiality and contend that this relationship is inadequately reflected in organizational studies that tend to ignore it, take it for granted, or treat it as a special case. The result is an understanding of organizing and its conditions and consequences that is necessarily limited. I then argue for an alternative approach, one that posits the constitutive entanglement of the social and the material in everyday life. I draw on some empirical examples to help ground and illustrate this approach in practice and conclude by suggesting that a reconfiguration of our conventional assumptions and considerations of materiality will help us more effectively recognize and understand the multiple, emergent, and shifting sociomaterial assemblages entailed in contemporary organizing.
There is current interest in the competitive advantage that knowledge may provide for organizations and in the significance of knowledge workers, organizational competencies and knowledge-intensive firms. Yet the concept of knowledge is complex and its relevance to organization theory has been insufficiently developed. The paper offers a review and critique of current approaches, and outlines an alternative. First, common images of knowledge in the organizational Literature as embodied, embedded, embrained, encultured and encoded are identified and, to summarize popular writings on knowledge work, a typology of organizations and knowledge types is constructed. However, traditional assumptions about knowledge, upon which most current speculation about organizational knowledge is based, offer a compartmentalized and static approach to the subject. Drawing from recent studies of the impact of new technologies and from debates in philosophy, linguistics, social theory and cognitive science, the second part of the paper introduces an alternative. Knowledge (or, more appropriately, knowing) is analyzed as an active process that is mediated, situated, provisional, pragmatic and contested. Rather than documenting the types of knowledge that capitalism currently demands the approach suggests that attention should be focused on the (culturally located) systems through which people achieve their knowing, on the changes that are occurring within such systems, and on the processes through which new knowledge may be generated.
In this paper, I outline a perspective on knowing in practice which highlights the essential role of human action in knowing how to get things done in complex organizational work. The perspective suggests that knowing is not a static embedded ca- pability or stable disposition of actors, but rather an ongoing social accomplishment, constituted and reconstituted as actors engage the world in practice. In interpreting the findings of an empirical study conducted in a geographically dispersed high- tech organization, I suggest that the competence to do global product development is both collective and distributed, grounded in the everyday practices of organizational members. I conclude by discussing some of the research implications of a perspective on organizational knowing in practice. (Distributed Competence; Geographically Distributed Organizing; Know- ing; Organizational Knowledge; Organizing Practices) With the intensification of globalization, acceleration in the rate of change, and expansion in the use of informa- tion technology, particular attention is being focused on the opportunities and difficulties associated with sharing knowledge and transferring "best practices" within and across organizations (Leonard-Barton 1995, Brown and Duguid 1998, Davenport and Prusak 1998). Such a focus on knowledge and knowledge management is particularly acute in the context of global product development, where the development and delivery of timely and innovative products across heterogeneous cultures, locales, and mar- kets are critical and ongoing challenges. Dealing effec- tively with such challenges requires more than just good ideas, strong leaders, and extensive resources; it also re- quires a deep competence in what may be labeled "dis- tributed organizing"—the capability of operating effec- tively across the temporal, geographic, political, and cultural boundaries routinely encountered in global operations.
Reflectivity in its most basic sense is focused contemplation and has been touted as an important skill for professionals in practice. As part of an effort to form an integrated theory of reflectivity as it occurs in clinical supervision, 5 experts in practitioner development were interviewed about the attributes of supervisee reflectivity. Respondents' statements from initial interviews were categorized and presented to respondents for discussion in a 2nd set of interviews. Grounded theory analysis (A. Strauss & J. Corbin, 1990) was used to derive a set of final categories. These categories included (a) causal conditions of new information and uncertainty; (b) intervening conditions of supervisee personality, supervisee cognitive capacity, and supervision environment; (c) the process of the supervisee's search for understanding of phenomena in the counseling session; and (d) change in the supervisee's perception, behavior, or long-term growth. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The idea of knowledge management draws currently much attention, both among practitioners and scholars. Advocates of the term argue that knowledge management points to a new set of phenomena and practices for managers to learn and master. In particular knowledge management focuses on the creation and distribution of knowledge in organizations through technological novelties such as the internet, intranets, and e-mail, although there are also streams concentrating on social relations and interactions. This paper examines several possible conceptualizations of the idea of knowledge management. It is argued that knowledge is an ambiguous, unspecific and dynamic phenomenon, intrinsically related to meaning, understanding and process, and therefore difficult to manage. There is thus a contradiction between knowledge and management. Drawing from a literature review and a case study, it is suggested that knowledge management is as likely, if not more so, to operate as a practice of managing people or information than as a practice attuned towards facilitating knowledge creation.
ABSTRACT Even though knowledge management scholars generally advocate explicit management of knowledge, there is research that cautions against the unintended consequences of such efforts. Some researchers go as far as arguing that knowledge and management are contradictory concepts (Alvesson and Kärreman, 2001). This paper explores the apparent double-edged nature of knowledge management by developing a theory-based framework that highlights different fundamental assumptions about knowledge and its management. This framework, which is an adaptation of Burrell and Morgan's four paradigms of social and organizational inquiry, distinguishes among a neo-functionalist, a constructivist, a critical and a dialogic discourse.
We use the contradiction of managing tacit knowledge, which has been highlighted in the knowledge management literature, as an analytical device to explore the four discourses in more detail. We show how notions of knowledge, and what it means to manage knowledge, vary across the four discourses. We conclude that all four discourses need to be appreciated, understood and represented in knowledge management research for this area of inquiry to deal with the rich and problematic nature of managing knowledge in practice.
The health care industry is increasingly becoming a knowledge-based community that is connected to hospitals, clinics, pharmacies, and customers for sharing knowledge, reducing administrative costs and improving the quality of care. Thus, the success of health care depends critically on the collection, analysis and seamless exchange of clinical, billing, and utilization information or knowledge within and across the above organizational boundaries. This research envisions a knowledge management-enabled health care management system that would help integrate clinical, administrative, and financial processes in health care through a common technical architecture; and provides a decision support infrastructure for clinical and administrative decision-making. Hence, the objective of this research is to present and describe the knowledge management capabilities, the technical infrastructure, and the decision support architecture for such a health care management system. The research findings would immensely help the health care information technology (IT) managers and knowledge based system developers to identify their IT needs and to plan for and develop the technical infrastructure of the health care management system for their organizations.
This chapter introduces and draws upon the other papers in this volume to address the issue of how task performance is achieved in workplace settings and the extent to which the knowledge needed for task performance is generic (that is, transcends workplace settings). Specific questions involving the mutual interaction of task performance, knowledge use, and people and artifacts are raised. The questions are then explored from a variety of theoretical frameworks, including cultural historical activity theory, cognitive theory, and socio-cultural and socio-linguistic theories.
Publisher Description of the book: This book addresses the concept of knowledge, and its use in the contexts of work and organizations. It provides a critical understanding of current approaches to knowledge management, organization and the 'knowledge economy'. The author describes a number of cases of 'knowledge intensive firms', including IT firms, management consultancy firms, advertising agencies and life science companies. He emphasizes the ambiguity of knowledge in the input, process, and output of professional work, and suggests that we should be careful in assuming too much about the nature, role, and effects of 'knowledge' in business life. Instead, we should understand the constructed nature of knowledge and scrutinize knowledge claims carefully. Alvesson looks at several aspects of management and working life, including human resource management issues, client control and the regulation of identity. Rhetoric, symbolism, image, the politics of knowledge claims, and identity are all shown to be crucial for understanding the management of 'knowledge intensive firms'. By challenging key assumptions in current thinking about knowledge and organization, a novel theoretical approach is suggested. The book will be of interest to business and management academics concerned with issues of knowledge and organization and will serve as supplementary reading for graduate and final year undergraduate business and management students.
Rationale Comparative effectiveness research (CER) is the study of two or more approaches to a health problem to determine which one results in better health outcomes. It is viewed by some in the USA as a promising strategy for health care reform. Aims and Objectives In this paper, nascent US CER policy will be described and analysed in order to determine its similarities and differences with EBM and its chances of success. Methods Document review and process tracing Results CER shares the logic of policies promoting evidence-based medicine, but invites greater methodological flexibility to ensure external validity across a range of health care topics. Conclusions This may narrow the inferential distance from knowledge to action, but efforts to change the US health care system through CER will face familiar epistemological quandaries and 'patient-centred' politics on the left and right.
This paper explores the concepts of knowledge culture and epistemic culture against the background of contemporary transformations in global society. Studies of knowledge culture came to prominence in the 1970s, with the trend towards laboratory fieldwork and direct observation in the new sociology of science. If the focus in such early studies was on knowledge construction, the focus in an epistemic culture approach by contrast is on the construction of the machineries of knowledge construction, relocating culture in the micropractices of laboratories and other bounded habitats of knowledge practice. Not all places of knowledge, however, are bounded spaces, and there is a case to be made for including in the empirical agenda more distributed locations. This is done here by introducing the concept of 'macro-epistemics', to describe wider networks of knowledge generation such as what is often known as 'the global financial architecture'. The discussion concludes by moving out from macro-epistemic circuits to questions of the cultural environment of epistemic settings, and of the more general knowledge culture in which specific knowledge processes are embedded.
L'A. s'efforce d'envisager la nature de la «socialite» et des relations sociales au sein des societes contemporaines marquees par des processus d'individualisation. Il se demande ce que signifie la notion d'individualisation, analyse les processus de transition post-sociale et met en lumiere certains phenomenes de «desocialisation». Il considere que les societes contemporaines vont voir emerger certains elements culturels tels l'expertise ou le savoir qui vont jouer un role de plus en plus important dans leur organisation. Il estime que les «relations d'objet» vont tendre a devenir de plus en plus constitutives des relations sociales. Il s'efforce de definir et de caracteriser les specificites d'une socialite centree sur l'objet et met en exergue les notions de mutualite et de solidarite dans ce cadre
The rise of the computer and the increasing importance of intellectual assets have compelled executives to examine the knowledge underlying their businesses and how it is used. Because knowledge management as a conscious practice is so young, however, executives have lacked models to use as guides. To help fill that gap, the authors recently studied knowledge management practices at management consulting firms, health care providers, and computer manufacturers. They found two very different knowledge management strategies in place. In companies that sell relatively standardized products that fill common needs, knowledge is carefully codified and stored in databases, where it can be accessed and used--over and over again--by anyone in the organization. The authors call this the codification strategy. In companies that provide highly customized solutions to unique problems, knowledge is shared mainly through person-to-person contacts; the chief purpose of computers is to help people communicate. They call this the personalization strategy. A company's choice of knowledge management strategy is not arbitrary--it must be driven by the company's competitive strategy. Emphasizing the wrong approach or trying to pursue both can quickly undermine a business. The authors warn that knowledge management should not be isolated in a functional department like HR or IT. They emphasize that the benefits are greatest--to both the company and its customers--when a CEO and other general managers actively choose one of the approaches as a primary strategy.
Clinical practice guidelines are one of the main tools by which clinicians, policy makers and patients hope to make health care less variable, more reliable and efficient, but there is little understanding of the processes by which clinical guidance is put together by guideline groups. This paper describes the social organisation of knowledge within clinical practice guideline development processes by drawing on the sociology of situated judgement. Two guideline development processes were observed, and the development group meetings (N = 21) recorded and analysed qualitatively. Data analysis suggested that clinical guidance comes to existence through the combination of repertoires of evaluation, organised around four different epistemic criteria: robustness, usability, acceptability and adequacy. This research provides a detailed and layered understanding of the knowledge dynamics involved in developing recommendations for appropriate health care for specific clinical circumstance.
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