Understanding the Concept of Knowledge in Healthcare Services: A Grounded Approach

The objective of this dissertation is to explore the meanings of knowledge as understood by senior medical staff in the UK’s National Health Service. It asks the question: 'What does it mean to know something?' The assumption is that an exploration of these meanings will help in designing systems to manage such knowledge. This is because the meaning of knowledge in the literature is contested and the models for its management are extremely variable, to the extent that it is proving challenging to establish knowledge management as an academic discipline or credible business tool. Twelve in-depth interviews were completed and analysed using a constructivist grounded theory approach. Six main categories were constructed. These are: finding motivating factors to pursue knowledge; interacting with knowledge sources; undergoing a process of knowledge acquisition; practising skills; seeking peers’ views; and, finally, building confidence as knowledge. Confidence was selected as the core category and the backbone of the constructed theory. The constructed theory argues that confidence is an important, integral aspect of our knowledge. One knows something if one thinks confidently that one knows it. Someone who understands a subject very well but lacks confidence simply does not know that subject. On the other hand, people can be overconfident or possess completely unjustified, misplaced confidence in situations where they lack understanding or ability. According to the emergent theory, these individuals are still knowledgeable, albeit in an incorrect or negative way. The emergent theory provides a new understanding of the concept of knowledge: knowledge as a type of emotion, i.e. confidence. This differs from the current understanding of knowledge, which views it as either objective information that requires cognitive processing or as human behaviour that influences practice. According to the emergent theory, knowledge is not necessarily a logical mental process nor purposeful human behaviour, but a fallible emotion, which can be harder to measure, observe or control than the two former phenomena. Confidence is an essential feature of knowledge and this thesis concludes by proposing a tool for confidence management within the NHS.