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Family medicine practice performance and knowledge management

Orzano, A. John; McInerney, Claire R.; Tallia, Alfred F.; Scharf, Davida; Crabtree, Benjamin F.

doi: 10.1097/01.HMR.0000304489.65028.75
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Background: Knowledge management (KM) is the process by which people in organizations find, share, and develop knowledge for action. KM affects performance by influencing work relationships to enhance learning and decision making.

Purpose: To identify how family medicine practices exhibit KM.

Methodology: A model and a template of KM concepts were derived from a comprehensive organizational literature review. Two higher and two lower performing family medicine practices were purposefully selected from existing comparative case studies based on prevention delivery rates and innovation. Interviews, fieldnotes of operations, and clinical encounters were coded independently using the template. Face-to-face discussions resolved coding differences.

Findings: All practices had processes and tools for finding, sharing, and developing knowledge; however, KM overall was limited despite implementation of expensive technologies like an electronic medical record. Where present, KM processes and tools were used by individuals but not integrated throughout the organization. Loss of information was prominent, and finding knowledge was underdeveloped. The use of technical tools and developing knowledge by reconfiguration and measurement were particularly limited. Socially related tools, such as face-to-face-communication for sharing and developing knowledge, were more developed. As in other organizations, tool use was tailored for specific outcomes and leveraged by other organizational capacities.

Practice Implications: Differences in KM occur within family practices and between family practices and other organizations and may have implications for improving practice performance. Understanding interaction patterns of work relationships and KM may explain why costly technical or externally imposed "one size fits all" practice organizational interventions have had mixed results and limited sustainability.

A. John Orzano, MD, MPH, Department of Family Medicine, Research Division, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 1 World's Fair Drive, Somerset; and Cancer Institute of New Jersey, New Brunswick. E-mail: orzanoaj@umdnj.edu.

Claire R. McInerney, PhD, School of Communication, Information and Library Studies, Rutgers, The State University of New Jersey, New Brunswick.

Alfred F. Tallia, MD, MPH, Department of Family Medicine, Research Division, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 1 World's Fair Drive, Somerset; Cancer Institute of New Jersey; and Center for Research in Family Medicine and Primary Care, New Brunswick.

Davida Scharf, MLS, School of Communication, Information and Library Studies, Rutgers, The State University of New Jersey, New Brunswick.

Benjamin F. Crabtree, PhD, Department of Family Medicine, Research Division, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 1 World's Fair Drive, Somerset; Cancer Institute of New Jersey; and Center for Research in Family Medicine and Primary Care, New Brunswick.

Grant support: Agency for Healthcare Research and Quality (K08 HS14018); Agency for Healthcare Research and Quality (R01 HS08776).

Presentation: 34th Annual North American Primary Care Research Group, October 16-18, 2006.

© 2008 Lippincott Williams & Wilkins, Inc.