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The organisational practices of knowledge mobilisation at top manager level in the NHS

The organisational practices of knowledge mobilisation at top manager level in the NHS. Davide Nicolini, Maja Korica and John Powell HSRN Managing the unmanageable? 5 December 2013.

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The organisational practices of knowledge mobilisation at top manager level in the NHS

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  1. The organisational practices of knowledge mobilisation at top manager level in the NHS Davide Nicolini, Maja Korica and John Powell HSRN Managing the unmanageable? 5 December 2013 This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 09/1002/36 ). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

  2. About the project • 2 year NIHR HS&DR-funded project • Research questions - How do NHS chief executives source and use knowledge and ‘evidence’? - What does being a chief executive in today’s NHS practically entail? • Method: • Qualitative, in-depth study • Shadowing of daily activity, min. 5 weeks each • Sample: 7 CEOs of NHS acute and MH trusts • Aim: Provide nuanced, rich accounts, not judgments or recipes

  3. Findings

  4. Knowledge mobilisation in theory

  5. Knowledge mobilization in practice “The CEO has been in the office since 7.25 am, listening to the news on the radio. By the time I arrived, he had checked the local press, dealt with emails and [social media], and read the documents for the afternoon meeting… By 08.35, he had 3 corridor meetings. He worked on and off for about 20 minutes on the presentation for the LET B meeting. At 08.50 there was a fire alarm. We stood outside for a good 15 minutes, during which the CE had four friendly business exchanges with different people, which allowed him, among other things to collect information on the Safety Month initiative. He also spoke to the Director of Public Affairs, the Chief Nurse and the deputy Chief Nurse, and told them about [a certain] meeting, repeating what he had told others, and developing further the rationale for new acquisitions…”

  6. Mobilizing knowledge as work Traditional’, by-the- book instances of K mobilisation rare K mobilisation as part of everyday CEO work and by-product of other activities Main practical concern: “am I knowledgeable enough to stay on top of the things that matter?”

  7. Four modes of making oneself knowledgeable in practice • Individual issue-specific search (rare). Mostly through delegating and establishing contacts with experts /friends • Meetings, monitoring key performance indicators, monitoring conversations • Impromptu conversations, open door, creating expectations, events, visits , walkabouts Unplanned by-product of doing other things

  8. What orients the attention of CEOs

  9. From information to intelligence to actionable evidence • What counts as actionable evidence constructed through work with the help of others

  10. lessons

  11. From knowledge mobilisation to knowledgeability • From seeking information or mobilizing ‘evidence’ to becoming knowledgeable: staying on top of the things that matter • What sources they use = red herring • A doing mostly accomplished with and through other people • A competence that can and should be developed and refined

  12. Personal Knowledgeability Infrastructure What manager should/do I want to be? What is my task at hand? What else is happening at the moment?

  13. PKI in practice: An example of a new acute CEO

  14. Pathologies of the PKI • Knowledgeability horizon like water for fish: you do not see what you do not see • Information inadequacy • Mismatch with the work to be done • Disconnect with wider context • Clash between structures and personal style • Importance of inner conversational circle

  15. Developing knowledgeability Where is my organization right now? What are the opportunities and challenges ? What kind of a manager/CEO do I wish or need to be? Do I have the right combination of people and tools in place to allow me to stay on top of things and accomplish what I feel I need to do? What is the nature of the broader competitive and regulatory context? What tools and ways of doing am I more comfortable with? Where do I want my organization to go?

  16. A reflective ‘roadmap’ for developing your knowledgeability • Take stock and look at what you do now • Get a coach to observe you, and then help you observe yourself and reflect • Use a trusted peer group and share how you operate • Assess (in partnership) whether your PKI is fit for purpose • Develop a personal plan to rebuild and enhance your PKI • What do you need to know? How do you know what this should be? Who or what will tell you when that may bewrong? • Set yourself the goal of continuous learning. Tie these to set dates in the diary to work toward on a structured and consistent basis.

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