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Social Science & Medicine 74 (2012) 1297e1304

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Social Science & Medicine

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Review

Knowledge mobilisation in healthcare: A critical review of health sectorand generic management literature

Ewan Ferlie a,*, Tessa Crilly b, Ashok Jashapara c, Anna Peckhamd

aDepartment of Management, King’s College London, 150, Stamford street, London, England SE1 9NH, United KingdombCrystal Blue Consulting, United KingdomcRoyal Holloway University of London, United Kingdomd Independent Consultant Librarian, UK

a r t i c l e i n f o

Article history:Available online 3 February 2012

Keywords:Knowledge mobilisationKnowledge managementEpistemologyTaxonomyInductive methodResource based viewCritical perspectiveOrganisationsLiterature review

* Corresponding author. Tel.: þ44 207 848 4466.E-mail addresses: ewan.ferlie@kcl.ac.uk (E. Ferlie)

ashok.jashapara@rhul.ac.uk (A. Jashapara), amgpeckha

0277-9536/$ e see front matter � 2012 Elsevier Ltd.doi:10.1016/j.socscimed.2011.11.042

a b s t r a c t

The health policy domain has displayed increasing interest in questions of knowledge management andknowledge mobilisation within healthcare organisations. We analyse here the findings of a criticalreview of generic management and health-related literatures, covering the period 2000e2008. Using 29pre-selected journals, supplemented by a search of selected electronic databases, we map twelvesubstantive domains classified into four broad groups: taxonomic and philosophical (e.g. different typesof knowledge); theoretical discourse (e.g. critical organisational studies); disciplinary fields (e.g.organisational learning and Information Systems/Information Technology); and organisational processesand structures (e.g. organisational form). We explore cross-overs and gaps between these traditionallyseparate literature streams. We found that health sector literature has absorbed some generic concepts,notably Communities of Practice, but has not yet deployed the performance-oriented perspective of theResource Based View (RBV) of the Firm. The generic literature uses healthcare sites to develop criticalanalyses of power and control in knowledge management, rooted in neo-Marxist/labour process andFoucauldian approaches. The review generates three theoretically grounded statements to inform futureenquiry, by: (a) importing the RBV stream; (b) developing the critical organisational studies perspectivefurther; and (c) exploring the theoretical argument that networks and other alternative organisationalforms facilitate knowledge sharing.

� 2012 Elsevier Ltd. All rights reserved.

Introduction and background

There is a well established literature on implementing clinicalevidence into practice, but less consideration of how managementand organisational knowledge gets into practice in healthcareorganisations. We here focus on the literatures on knowledgemanagement and knowledge mobilisation (the latter term ispreferred as it is looser, signalling unplanned outcomes or possibleresistance). These literatures have expanded both in relation tohealthcare organisations and the broader generic managementdomain.

Both literatures have strong relevance for UK healthcare, givenmajor policy initiatives to overcome ‘translation gaps’, not onlyfrom basic science to clinical trials (the first translation gap) butusing knowledge management based approaches to change

, TECrilly@aol.com (T. Crilly),m@gmail.com (A. Peckham).

All rights reserved.

healthcare delivery (the so called second translation gap, ofconcern here) (Treasury, 2006). A stage-like model of transfer isevident in the policy domain: ‘in this context, knowledgemanagement, from research observation to routine clinical prac-tice, can be broken down into four discrete activities: knowledgeproduction, knowledge transfer, knowledge reception and knowl-edge use’ (Cooksey in Treasury, 2006, p. 99). As social science workin the parallel diffusion of innovations literature (Greenhalgh,Robert, Macfarlane, Bate, & Kyriakidou, 2004) indicates, suchmechanistic models do not consider the extent to which newpractices (or here knowledges) are reinterpreted locally, displaysuperficial and ‘face’ adoption, or can be followed by later unad-option. Cooksey ambitiously implied that the healthcare systemshould detect and absorb new knowledge and use it to changeworking practices across a vast organisational field. To think moreclearly about how to address this ‘second translation gap’, health-care scholars and policy makers need to access more behaviouraland social science based literature(s).

We here discuss a recent literature review of social sciencebased work in the field of knowledge mobilisation (Crilly,

E. Ferlie et al. / Social Science & Medicine 74 (2012) 1297e13041298

Jashapara, & Ferlie, 2010). What distinguishes this review is inclu-sion of the generic management literature alongside specifichealthcare literature, thus accessing a broader range of ideas andtheoretical traditions. It also reviews the literature streams criti-cally, examining their theoretical and empirical positioning,analytical strengths and weaknesses. Its scope is broader than thatof previous reviews. Mitton, Adair, McKensie, Patten, and Perry(2007) primarily focus on knowledge transfer and exchangebetween researchers and users in the healthcare sector and do notaddress broader utilisation issues, including technology, cultureand organisational learning. (Contandriopoulos, Lemire, Denis, andTremblay (2010) and Ward, Smith, Foy, House, and Hamer (2010)also concentrate on knowledge exchange and translation litera-tures). Similarly, Greenhalgh et al. (2004) approach knowledgeutilisation as an interdisciplinary sub-set of the diffusion of inno-vation literature which is a particular and defined perspective.Nicolini, Powell, Conville, and Martinez-Solana (2008) adopta broader definition of KM in reviewing the enablers and barriers ofknowledge management processes, but retain a specific healthsector focus. We examine cross-overs that have occurred betweenthese two literature streams, as well as continuing gaps, andpropose a future research agenda based on three theoreticallyinformed themes which emerge from the initial review.

Methods: a phased literature review 2000e2008

We structured the review by selecting 29 academic journals(Phase 1), using the UK Association of Business Schools and Web ofScience rankings as a guide to identifying ‘high quality’ journals, andthen snowballing to earlier references. Within this phase, thegeneric management literature (20 journals) was reviewed first andthen the healthcare literature (9 health and social science journals).It was later supplemented bya search of electronic databases (Phase2) to capture practitioner/grey literature and further peer-reviewedarticles. ‘Knowledge’, ‘evidence’ and ‘research’ were the key termsused to inform the Phase 1 hand-search, yielding 585 abstracts(414 management and 171 health/social sciences). A rating processamong three researchers, matching titles/abstracts for relevanceto the theme of Knowledge Mobilisation, produced a set of 183management and 68 health-related papers to review, totalling 251in all. Narrowly biomedical scientific or pharmacological studieswere excluded. Phase 2 searched databases (Medline, Embase,HMIC and CINAHL) using terms informed by the first phase,including: knowledge management, transfer, sharing, capture,mobilisation, exchange, transmission, translation, diffusion andknowledge/research/evidence utilisation and implementation. Itderived 548 titles, used to cross-check the comprehensiveness ofPhase 1. The search terms are connected since “research is oftenseen as one form of evidence, and evidence as one source ofknowledge” (Nutley, Walter, & Davies, 2007, p. 23). ‘Knowledge’ isthe broadest term, allowing for empirical, theoretical and experi-ential ways of knowing.

A thematic framework of the field was developed, based on coretheoretical content. The review thus steered away from listingbarriers and enablers of knowledge mobilisation (e.g. covered ablyby Mitton et al., 2007; Nicolini et al., 2008), and had more incommon with Greenhalgh et al. (2005)’s method which identified‘storylines’ in the diffusion of innovations literature. It wouldtherefore be accurate to describe our analytic approach as “anadaptation of meta-narrative review”. A set of ten substantivedomains was identified in the management literature searched: (i)types of knowledge, nature of knowledge and knowing; (ii) infor-mation systems/information technology; (iii) communities ofpractice; (iv) organisational form; (v) organisational learning; (vi)resource based view of the firm; (vii) critical organisation studies;

(viii) positivist models of knowledge transfer; (ix) barriers; (x)culture and communication. An eleventh was located throughsearching the health journals; (xi) evidence-based practice. Phase 2produced a twelfth domain; (xii) R&D ‘superstructures’, dealingwith supply/demand macro structures of funding and research-commissioning.

The domain taxonomy was a negotiated framework, synthesis-ing the principal investigator’s dominant classification with themapping by each researcher. Distinction between theoreticalperspectives, rather than preference for any particular theory,drove the categorisation, which depended on prior knowledge ofthe field. The team was multidisciplinary, with backgrounds inmanagement studies, economics, health and social policy,psychology, knowledge management and healthcare managementexperience.

When we documented our findings, 684 sources were cited. AnAppendix includes further details of methods and the articles wereviewed.

Mapping the terrain through induction

Each paper was assigned to a single ‘leading’ domain, eventhough material frequently had a cross-cutting element. The socialpractice perspective of Orlikowski (2002) and Brown and Duguid(2001), for example, was located in Communities of Practice, butwas integral to understanding Types of Knowledge and Knowing.The inductive approach allowed for the handling of early ambiguity,since the papers did not form themselves neatly into either-orcompartments. We avoided a dualist ‘this but not that’ form ofanalysis frequently used as a ‘theoretical scaffolding for schemes ofclassification, taxonomies and contingency theory’ (see Schulze &Leidner, 2004, p. 553). Most taxonomies organise ideas aroundpolar dimensions, often represented in a four-field typology, e.g.personal-technical, explicit-implicit, to describe types of knowl-edge. Our domain structure emerged inductively and, like knowl-edge itself, “loose, ambiguous, and rich” (Alvesson & Kärreman,2001, p. 1012), retained messy boundaries. In mapping theterrain, as in topography, the landscape was neither regular norgeometric. The analysis was not tied to a predefined framework,thus avoiding shoe-horning concepts into theoretical frameworksregardless of fit (Rynes, Bartunek, & Daft, 2001). The price, however,is little symmetry; the emerging domains are irregular in size anddo not nest into either-or polar dimensions.

What did we find?

We first of all describe the content of the literatures searched,setting the twelve domains within four broad groupings. Inter-relationships between these domains, together with their domi-nant academic discipline (e.g. social psychology underpins theorganisational learning stream) and mode of enquiry (e.g.ethnography is dominant within the cultural stream), are sum-marised in Table 1. The matrix shows the frequency with whichpapers were coded to each domain in the management journalsearch (Mj), health journal search (Hj) and electronic search ofhealth databases (He).

Taxonomies and philosophical enquiry

A major question is: ‘what is knowledge and how do we knowwhat we know?’ The starting point among authors in The Nature ofKnowledge and Knowing domain is a hierarchy of data-information-knowledge, depicted as a continuum in which “data requireminimal human judgement, whereas knowledge requiresa maximum judgement” (see Tsoukas & Vladimorou, 2001, p. 976).

Table 1Frequency of papers across domains within each search (where Mj, Hj He each total 100%).

Grouping/Domain Description Related discipline/modeof enquiry

Relationship with other domains % papers

Taxonomy and philosophical enquiry

Type of Knowledge, Natureof Knowledge andKnowing

Produces taxonomies, e.g. tacit-explicit,hard-soft and explores how we knowwhat we know.

� Philosophy� Epistemology

Underpins all other domains Mj 19%Hj 18%He 11%

Evidence BasedManagement/Medicine

‘Evidence’ features in healthcare,whereas ‘knowledge’ is found more ingeneric literature.

A health sector version of ‘type ofknowledge’ debate; critiques of EBMdraw on situated learning andCommunities of Practice perspectives.

Mj e

Hj 31%He 20%

Theoretical positions

Resource Based View of theFirm (RBV)

Theory that the firm is the sum of itsassets, including Knowledge.Competitive advantage is gained byprotecting or mobilising resources.

� Economics� Strategic Management

Underpins all positivist domains wherecompetitive advantage is a goal, as inKT.

Mj 9%Hj e

He 1%

Communities of Practice(CoP)

Theory that groups of like-mindedpeople learn through common purposeand through doing (rather thandescribing).

� Anthropology� Ethnographic Studies

Knowledge is tacit, embedded,relational and sticky. Links with Type ofKnowledge and Organisational Form,e.g. networks.

Mj 10%Hj 6%He 9%

Critical OrganisationalStudies

Not a unified theory, but a criticalperspective rooted in Foucault andMarxist/labour process theory, whereknowledge management is a source ofpower, oppression and control and canprovoke resistance.

� Sociology Polarised against RBV and positivistmodels of Knowledge Transfer; alsoantipathetic to IS/IT which is seen asa mechanism of control.

Mj 6%Hj 2%He 1%

Disciplinary fields

Information Systems &Technology

More action than theory-driven; oftenbased on codified knowledge butlatterly looking at human factors inmaking systems work.

� Information Science� Implementation

Many overlaps, e.g. a medium oftransfer or a barrier; opposed by CriticalScholars as a means of oppressing theworkers; codified knowledge of IS/ITpolarised against ‘soft’ relationalCommunities of Practice knowledge.

Mj 4%Hj 9%He 11%

Organisational Learning(OL)

OL is an emergent and diffuse field.Learning and Unlearning are prominentthemes.

� Human Resources Management� Psychology and cognition

Linked to Type of Knowledge, e.g.cognivitist-constructivist;Organisational Form.

Mj 15%Hj 6%He 11%

Flows, processes and structure

Organisational Form Design of organisation, e.g. networksrather than markets or hierarchies, mayinfluence knowledge-sharing capacity.

� Organisational Studies Organisational form is not easilydisentangled from OL, processes of KT,or RBV of the firm.

Mj 12%Hj 5%He 5%

Knowledge Transfer (KT) &Performance

Knowledge management is a ‘goodthing’; knowledge is increased throughinnovation.

� Flow models of transfer Knowledge is an asset, as in RBV. Mj 14%Hj 15%He 8%

Barriers to Transfer &Facilitators ofOrganisationalDevelopment

This domain explores why knowledgefails to transfer or, conversely, howflows of knowledge lead toorganisational change anddevelopment, with a focus on humanresources.

� Human Relations� Frameworks, case studies

Culture is a major barrier, so overlapswith Culture & Communication. Differsfrom KT processes, because knowledgeis a product of human interactions. Inthis respect, connects with OL.

Mj 8%Hj 6%He 17%

Culture & Communication This is a small domain, usingethnographic methods.

� Anthropology� Ethnography

Arguably a sub-set of Barriers toTransfer, since Culture is the majorbarrier.

Mj 3%Hj 2%He 1%

R&D Superstructures Deals with macro supply and demandstructures of research commissioningand funding.

Health-specific and policy orientateddomain, concerned with the academic-practitioner divide across CoP.

Mj e

Hj e

He 4%

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A distinction between tacit and explicit knowledge is attributed toPolanyi (1962) and developed by Nonaka (1994). Orlikowski (2002)moves from the noun knowledge, “connoting things, elements,facts, processes, dispositions” (p. 251) to the verb knowing,“connoting action, doing, practice” (p. 251). Gourlay (2006) usespolarity of opposites, e.g. tacit-explicit, to generate a typology ofsoft-hard, inarticulable-codifiable types of knowledge. Orlikowski’saccount of ‘embedded practice’ challenges the idea that ‘bestpractices’ can be readily transferred. Weick (1995)’s concept of‘sensemaking’ argues that people need to make sense of complexproblems to resolve them. ‘Sensemaking’manages the confusion of

‘equivocality’ and uncertainty of ‘ambiguity’ which beset peoplewhen faced with unfamiliar situations. Organisational and personalstories are diagnostic tools and repositories of tacit knowledgewhich help make sense. Such narrative based and qualitativeknowledge contrasts with logico-scientific-deductive reasoning.

Evidence Based Healthcare is the largest domain within thehealthcare literature. Evidence Based Medicine (EBM) gainedmomentum in the 1990s, spawning an interest in EvidenceBased Management (Walshe & Rundall, 2001). In the latter partof our review period, there is a reaction against early EBM’scertainty (e.g. Goldenberg, 2006). Absence of the patient voice

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is one major criticism, highlighting conflict between EBM andnarrative methods. Personal experience ranks lowest on thehierarchy of evidence model, whereas critical literaturedemands greater credence. Lambert (2006) resists EBM’sincursions in favour of the patient-centred ‘Narrative-BasedMedicine’. It is paradoxical, Lambert observes, that the goldstandard of randomized control trials is privileged in EBM whenqualitative research is increasingly legitimised in the socialsciences.

Theoretical positions

The Resource Based View of the Firm comes from industrialeconomics and strategic management. The firm produces value,exploiting knowledge as an intangible asset. The organisation or firmgains competitive advantage by protecting and mobilising its coreresources (Penrose, 1959; Barney, 1991; Wernerfelt, 1984). Subse-quent debates attempt to integrate relational and resource-basedviews of knowledge, e.g. by linking trust and performance in stra-tegic alliances (Connell & Voola, 2007). Teece, Pisano, and Shuen(1997)’s research on dynamic capability accommodates organisa-tional change over time: dynamic capabilities are “the firm’s abilityto integrate, build, and reconfigure internal and external compe-tences to address rapidly changing environments” (p. 516).

Critical theoretical perspectives oppose the Resource Based View(RBV), highlighting instead the contestability of managementknowledge, the social limits of technology (e.g. Currie & Kerrin,2004) and the importance of power relations in KM. Alvessonand Kärreman (2001) juxtapose ‘knowledge’ and ‘management’as an ‘odd couple’ given that knowledge is so difficult to manage.Such analysis typically explores questions of domination andresistance where KM is recast as a managerial tool of control.Foucault (1977, 1980) is a major theorist in this stream, providingnovel and sophisticated concepts of power. His work focusses ongoverning ‘conduct’ through classification, surveillance and selfsurveillance, intensified by new electronic information systems(Doolin, 2004). Subjects (e.g. clinicians under electronic surveil-lance) may resist and engage in ‘counter conduct’.

Communities of Practice (CoPs) are groups of people who, throughworking together, develop into a cohesive work community withmutual understandings. There may be strong barriers in knowledgeflow between CoPs so knowledge can ‘stick’ as well as ‘flow.’ Thisdomain draws on social psychology and micro sociology, empha-sising shared cognitions emerging though repeated interactions atwork. It shifts focus from technical solutions towards social factors,notably tacit knowledge shared through ‘situated learning’ (Lave &Wenger, 1991, p. 98). ‘Knowing’ is part of becoming an insiderwithin a community of practice and individual knowledge is lessimportant than communal knowledge that builds up over time.

Disciplinary fields

Information Science/Information Technology (IS/IT) literature ismore action than theory-driven. Its attraction to codified knowl-edge and application lends itself to ‘toolkits’ and formalisedimplementation frameworks. IS/IT papers retrieved are of twotypes. One group is empirical, surveying or testing technical solu-tions, but the (small) second group takes a philosophical view,debating the personalised and the codified (Hansen, Nohria &Tierney, 1999). Personalised approaches are supported by knowl-edge directories (e.g. yellow pages) and knowledge networks (e.g.electronic communities of practice); codified approaches are sup-ported by electronic knowledge repositories, storing codifiedknowledge for future reuse. Health literature papers focus onclinical decision support systems, e.g. linking characteristics of

patients with chest pain to software algorithms recommendingspecific action (Garg et al., 2005).

Organisational Learning (OL) is a diverse literature that builds onthe RBV assumption that competencies confer competitive advan-tage. The organisation is characterised as an entity shaped by itscollective cognitive capacity. Strategic learning is a planned (ratherthan emergent) form of organisational learning which supportsorganisational goals, thereby creating a performance advantage. Theconcept of ‘absorptive capacity’ refers to an organisation’s effective-ness in sensing, acquiring and using new knowledge (Inkpen, 2000).

Flows, processes and structure

The remaining four domains collectively make up the largestgrouping, describing the structures and dynamic processes ofknowledge mobilisation.

The Knowledge Transfer domain takes a functionalist approach,in which knowledge is commodified as an asset that can be ‘movedaround’ to augment organisational performance. Transfer is alter-natively described as diffusion, sharing, and may be related toadoption of innovation. Newell, Swan, and Galliers (2000) studiedBusiness Process Reengineering as an idea or technology that wasblackboxed by suppliers as a means of pushing ideas, allowingreceptive users to pull them into the organisation. The domainincorporates dynamic models of knowledge sharing (e.g. Parent,Roy, & St-Jacques, 2007).

Barriers to Transfer & Facilitators of Organisational Development(OD) is a domain that sees the organisation as amalleable entity, ableto grow through knowledge sharing. This stream takes a relational or“soft” view of knowledge, influenced by sociology, human resourcesmanagement and management learning. Papers generally use casestudymethods to explore barriers and enablers to knowledge flows.Empson’s (2001) case study of a Professional Service Firm mergeridentified fear of exploitation and ‘contamination’ as impedingknowledge transfer. In the health literature, organisational barriersto knowledge transfer (Mitton et al., 2007) include negative cultureand poor researcher incentive systems, while facilitators includetraining, authority to implement changes, readiness to change andcollaborative research partnerships. Poor personal contact betweenresearchers and policy makers is a frequently reported barrier, as iscontestable evidence (Nutley et al., 2007).

Culture and Communication is a small domain covering knowl-edge boundaries, communication and culture, explored throughethnographic approaches (e.g. Carlile, 2002; Swan, Bresnen,Newell, & Robertson, 2007).

The Organisational Form domain considers ‘what impact doesthe underlying organisational form have upon knowledge mobi-lisation?’ This literature draws on organisational studies, focussingon structures (Birkinshaw, Nobel, & Ridderstrale, 2002) anddistinctive organisational forms including: Joint Ventures andstrategic alliances (Inkpen, 2000); Knowledge Intensive Firms (suchas consultancy companies) and Professional Services Firms (such aslaw firms) (Empson, 2001). It explores how new virtual organisa-tions affect knowledge brokering (Verona, Prandelli, & Sawhney,2006). Health literature shows little interest in organisationalform, apart from specific foci on clinical governance and managedcare (e.g. Dixon, Lewis, Rosen, Finlayson, & Gray, 2004).

The last domain is termed R&D Superstructures, referring to thehealth research institutional complex. Phase 2 located a smallstream of literature examining R&D infrastructure. Allen, Peckham,Anderson, and Goodwin (2007) consider how public commis-sioners of such research could fund ‘useful’ research, concludingthat interaction between decision makers and research commis-sioners is essential.

E. Ferlie et al. / Social Science & Medicine 74 (2012) 1297e1304 1301

We now move from describing content to some analyticalobservations about how the literature streams are developing overtime.

Time-line trajectories: from simple rules to complex processes

The review concentrated on the 2000e2008 period, witha backward glance through snowballed references. IS/IT was theinitial core of the knowledge management movement. Easterby-Smith, Crossman, and Nicolini (2000) noted that 70% of publica-tions on KM pre 2000 were written by information specialistsfocussing on technical issues such as database design. They antic-ipated, correctly, that debate would shift towards the humandimension since social factors were impairing IS/IT implementa-tion. We see a progression from explicit rule-based beginningstowards a concernwith relationships and interaction, where powerand context are important factors. Later knowledge transfer work(Parent et al., 2007) rejects the traditional linear model of knowl-edge transfer for more processual notions of ‘transfer capacity’, inresponse to insights from Communities of Practice and networkbased work.

This trajectory from simple to complex over time recurs in otherdomains. Nutley et al. (2007, pp. 91e92) described how writing onthe research process moved from (i) early models of “rational,linear and one-way relationship between research and policy/practice” to (ii) multi-dimensional models, to (iii) relational,interactive and then to (iv) post-modern accounts “in which anal-yses of power are brought to the fore”. This temporal progression isechoed in the developmental model of individual learning inmedical students (Knight & Mattick, 2006). Medical studentsinitially showed simple unreflective ‘belief’ before moving to reli-ance on expert knowledge provided by authorities. A quasi-reflective stage came next, dealing with high uncertainty, fol-lowed by the reflective or ‘sophisticated’ stage where studentsactively constructed solutions based on interpretation and context.Knight & Mattick’s findings validate Polanyi’s insight into howa medical student looks at an x-ray without comprehension andthen makes sense of it through personal study and experience. Theknowledge is personalised and tacit rather than explicit: “we knowmore than we can tell” (Polanyi, 1966, p. 4).

Although attractive, the presumed evolutionary path fromdata toinformation to knowledge to wisdom (the DIKW model; Ackoff,1989) may be over-played. This trajectory is itself a hierarchy, butone rejected as a guiding model by the reflective/contextual‘wisdom’ stage. The academic literature reviewed tends to privilegetacit knowledge, implying wisdom, above explicit knowledgesourced through data and information (Alavi & Leidner, 2001). Thisepistemological trend towards abstraction and complexity wasrebalanced somewhat in the generic management literature by itsgreater interest in performance and competitive advantage. Thequestion of ‘what knowledge?’ (Schultze & Leidner, 2002) gave wayto ‘what performance?’ (Haas & Hansen, 2007). The pros and cons ofcodified knowledge versus personalised or interactive knowledge forcompetitive advantage were explored (Dyer & Hatch, 2006).

The health management literature also charts a simple-complexprogression. Until 2003, the evidence-based management agendadominated this literature, using the biomedical hierarchy ofevidence as a point of reference (e.g. Dopson, Locock, Chambers, &Gabbay, 2001; Niessen, Grijseels, & Rutten, 2000). Tranfield, Denyer,and Smart (2003) argued that evidence acquired through system-atic methods is privileged and that narrative methodology lacksrigour. Nevertheless, the linear model was meeting criticism.Freeman and Sweeney (2001)’s critique of EBM argued that formalclinical evidence did not necessarily fit with the patient’s life andthat hierarchical EBM implementation was unrealistic. Their

qualitative study found that General Practitioners saw theirpatients’ lives in the round so that evidence was ‘a square peg to fitin the round hole of the patient’s life’. Generic management-basedtheories of Communities of Practice moved into healthcare orga-nisations (e.g. Bate & Robert, 2002). Gabbay & Le May’s (2004)ethnographic study of tacit ‘mindlines’, as constructed collectivelyin primary care, rejected hierarchically determined evidence-basedguidelines for a ‘sensemaking’ perspective. An epistemological turntook place from 2004 onwards, when different ways of knowingwere increasingly explored, such as narrative methods (Greenhalghet al., 2005).

Comparative analysis: cross-overs and gaps

Is there cross-over between the generic management andhealthcare literatures or do they inhabit distinct epistemicCommunities of Practice? We consider four categories in turn.

(a) Cross-Over from Generic to Health Management occurred whenBate and Robert (2002) introduced Communities of Practicetheory. CoP shifted attention away from macro systemstowards the micro level of practitioner communities. Theconcept fits easily with the multi professional groups ofdoctors, nurses and indeedmanagers who negotiate to produceshared understandings and work practices. The possibility ofseparated epistemic communities (Brown & Duguid, 2000)reconceptualises the gap between academics and practitionersin blocking knowledge transfer.

(b) Within the Health Management Literature. The vacuum betweenresearch and practice is a major healthcare theme. Manage-ment interest in knowledge mobilisation and research uti-lisation has its origins in biomedical approaches to Researchand Development (Peckham, 1991). Cooksey (Treasury, 2006)linked biomedicine, research and management practicethrough the ‘bench to bedside’model of knowledge translation,identifying translation gaps. The gulf between research andpractice has been conceptualised through the ‘two communi-ties’ thesis (Caplan, 1979; Wingens, 1999), which seesresearchers and practitioners as living in separate worlds,responding to different incentives and speaking differentlanguages. Macro level policy makers may be more receptive toevidence than local managers: “research evidence is moreinfluential in central policy than local policy, where policy-making is marked by negotiation and uncertainty” (Black, 2001,p. 277).The ‘R&D Superstructures’ domain describes macro struc-

tures that have emerged for commissioning and disseminatingresearch into health. In the UK perhaps 0.6% of GDP is devotedto health-related R&D, requiring an infrastructure to commis-sion and manage it (Crilly et al., 2010). The generic manage-ment literature is by contrast pitched at the meso level of thecompetitive firm. Health literature on research utilisationfocuses more on evidence-based practice, including the top-down implementation of national clinical guidelines (Davies,Nutley, & Smith, 2000). The use of the words ‘evidence’ and‘research’ in health contrasts with ‘knowledge’ in management.Evidence Based Policy and Management, drawn from

Evidence Based Medicine, is a healthcare orientated discourseand has no strong corollary in the generic management spherehistorically, although a similar movement is now developing insome generic management literature, linked to the HumanResource Management discipline where psychological researchmethods are widely used, e.g. Rousseau and McCarthy (2007).

(c) Cross-Over from Healthcare to Generic Management occursthrough authors who publish in both literature streams or

E. Ferlie et al. / Social Science & Medicine 74 (2012) 1297e13041302

analyse healthcare settings (a major sector of interest beyondhealthcare) within generic management literature. Unsur-prisingly, such writers on the health sector often explorepower contests between occupational groups, e.g. thedoctoremanager relationship. Health contexts are of greatinterest to critical social scientists (Lee & Garvin, 2003), oftendrawing from Foucauldian or neo Marxist/labour processframeworks. Examples include: Doolin’s (2004) Foucauldiananalysis of resistance to medical management informationsystems; see also Currie and Kerrin (2004); Currie, Waring,and Finn (2008); Hanlon et al. (2005). Programme renegotia-tion at local level, implementation failure and employeeresistance are common themes.

(d) Within Generic Management. The RBV stream is prominent inthe management literature but notably absent from healthjournals. Easterby-Smith & Prieto summarise the RBVperspective: “each organization possesses a different profile oftangible and intangible resources and capabilities, and thesedifferences account for variations in organizations’ competitivepositions and their performance. The core principles of theresource-based view are that resources and capabilities whichare simultaneously valuable, rare, imperfectly imitable andnon-substitutable e the VRIN conditions e are the main sourceof above-normal rents and competitive advantage.”

(Easterby-Smith & Prieto, 2008, p. 236). The generic manage-ment literature is underpinned by the assumption that orga-nisations are firms seeking competitive advantage. Lam (2000)notes that knowledge is increasingly regarded as the criticalresource of firms and that tacit knowledge helps securecompetitiveness, technological innovation and learning. Theemphasis is upon knowledge as a source of performance andsustained competitive advantage. This domain separatesgeneric management from health management literatures.

Three theoretically informed statements to structure futureenquiry

We here explore implications of our review for future enquiry,asking where are the main gaps in the current literature and howmight it fruitfully develop. We place suggested future work withina clear social science positioning.

Firstly, and as noted, RBV ideas do not feature in current healthliterature. RBV theory brings in important ideas from industrialeconomics (Penrose, 1959) and strategic management (Teece et al.,1997), distinctively focussing on themes of productivity, perfor-mance and competitive advantage. Given the different market,incentive and value structures traditionally apparent in healthcareorganisations as opposed to private firms, this absence may havebeen appropriate. There may be an increasing role in health orga-nisations for RBV perspectives, given recent shifts in UK healthpolicy to open up markets in healthcare and pressures to improveproductivity and performance (Department of Health, 2010). Somehealth systems internationally are alreadymarket driven (e.g. USA);moremay bemoving in that direction. If so, we argue RBV ideas willcross into the health management literature. There is someevidence that this cross-over is now happening. Walshe, Harvey,and Jas (2010) explore a knowledge based perspective on organ-isational performance in public sector and healthcare reform;Casebeer, Reay, Dewald, and Pablo (2010) specifically developa RBV/dynamic capabilities perspective on Canadian healthcareorganisations.

However, two questions arise from this position. One is thedemanding intellectual task which emerges: how to apply suchstrategic management themes deriving from the study of privatefirms to what may remain ‘quasi firms’, located in between classic

private and public sectors. There is a small strategic managementliterature on such settings (Ferlie, 1992; Joyce, 1999) but it requiresfurther theoretical development. Secondly, there may be skills andcompetences gaps in the current health services research work-force, as there are few strategic management scholars working inthe field.

STATEMENT 1: “Healthcare scholars and policy makers will wishto consider how the mobilisation of knowledge can improveproductivity, innovation and performance in more market drivenhealth systems. The Resource Based View of the firm has potentialapplication.”

Secondly, the critical perspective is polarised against the RBVstream and offers an alternative theoretical prism. Criticalmanagement studies often take healthcare settings as empiricalsites as they illuminate power struggles between doctors,managers, nurses and are shaped by a strong political and organ-isational context.

What main theoretical themes emerge from a critical perspec-tive? The first is continuing sectoral difference from private sectorsettings. Currie et al. (2008, p. 282) reject the application of private-sector models: “Inappropriately imported models of private sectormanagement take little accountof thedistinctiveproperties of publicsector organizations. [N]aïve application of external, businesssector and managerial policies. are ill suited for the complexitiesand cultures of the NHS.” The specific organisational context shapesthe impact of knowledgemobilisation efforts. Critical perspectives inturn subdivide into a neo Marxist/labour process school and Fou-cauldian approach: in the spirit of labour process theory, Alvessonand Kärreman (2001) argue that knowledge management systemsmake work processes codified and transparent, enabling theorganisational elite to extract value through work intensification;Doolin (2004) applies Foucault’s ideas to electronic knowledgemanagement systems in healthcare organisations as they extendcentral surveillance over clinical work practices, provoking clinicalresistance. These critical perspectives see organisational powerrelations, professional autonomy, workforce resistance and also (inFoucauldian terms) workforce self surveillance as significant. Thenon-implementation of knowledgemanagement systems is possibleas it may be rational for workers to hoard rather than to shareknowledge, to maximize their value to the organisation and theirpower base within it. Both streams of literature are shaped bydistinctive social science ideas which differ markedly from thepositivistic, functionalist andmanagerialist tone ofmuch knowledgemanagement literature. They can only be understood from withintheir own internally coherent conceptual system.

STATEMENT 2: “Critical perspectives e especially labour processand Foucauldian perspectives - explain why many knowledgemanagement systems fail in healthcare. The importance of powercontests among occupational groups in health systems makes itappropriate to temper positivistic and technical approaches toknowledge management with scepticism.”

Thirdly, themeso or organisational level of analysis has too oftenbeen neglected in the healthcare literature which often gravitatesto micro analysis. The generic organisational studies stream ofliterature is well equipped to explore possible organisational leveleffects on knowledge mobilisation efforts. What characteristics of(healthcare) organisations are likely to promote learning andeffective use of knowledge and research? Themove inmany sectorsfrom simple hierarchy to various alternative organisational formssuch as strategic alliances, Joint Ventures, networks, virtual orga-nisations, collegial Professional Service Firms or KnowledgeIntensive Firms is theoretically seen as significant and helpful in

E. Ferlie et al. / Social Science & Medicine 74 (2012) 1297e1304 1303

promoting organisational knowledge acquisition and use. If (as itprima facie appears) the healthcare sector is also moving away fromvertically integrated and hospital based forms to looser partnershipand network based structures (6, Goodwin, Peck, & Freeman, 2006),particularly in the fields of long term or complex conditions, thenthese literatures have an increasing read across to healthcare.

There is here a theoretical bias for networks and partnerships,rather than hierarchies or markets, as a form which stimulatesorganisational learning (Adler, 2001). However, empirical studies ofthe learning capacity of healthcare networks have been inconclu-sive (Addicott, McGivern, & Ferlie, 2006), as learning can be crow-ded out by urgent policy objectives, notably restructuring.

This organisational form literature should now be explored andrefined further, to identify: (i) the presumed theoretical effects ofalternative organisational forms for knowledge mobilisation moreprecisely, (ii) their application to healthcare organisations and (iii)where theoretical predictions are confirmed by empirical studies inthe healthcare sector.

STATEMENT 3: “The organisational studies perspective argues thatappropriate organisational forms support knowledge mobilisationefforts. Theoretically, alternative partnership and network-basedorganisational forms are seen as more effective in promotingknowledge sharing than markets or hierarchies, but we now needto review further studies in healthcare organisations to refinetheory and match it with empirics.”

Concluding discussion

The knowledge mobilisation perspective has emerged as animportant strand in UK health policy in response to an identified‘second translation gap’ (Treasury, 2006) whereby new knowledgedoes not readily translate into practice across the clinical field.Understanding this gap requires a grounding in relevant socialscience literature(s) and cannot just be explored through a technicistknowledge management literature. Our review of these expandingand diffuse literatures identified manyeand increasing overtimeevoices anddisciplinary traditions. It also described a trajectoryfrom the simple to the complex and from the technical to the social,revealing an increasing interest in fundamental questions of epis-temology: what do we know and how do we know it? Much of theliterature reviewed is international in nature rather thanUK specific.

Unusually, we have reviewed general management as well ashealthcare-specific literatures. We highlighted the existing (e.g.Communities of Practice) and potential (e.g. Resource Based Viewof the Firm) cross-overs between both these streams, as bothliteratures are underdeveloped in some areas. We explored theutility of expanding the scope of healthcare literature by bringing in(i) RBV perspectives, (ii) Critical management studies, both froma neo Marxist/process theory and a Foucauldian perspective and(iii) organisational studies on the relationship between knowledgemobilisation and alternative organisational forms. Translated intoapplied research, the competing perspectives of RBV and criticaltheory ask whether private sector models can be successfullyimported into healthcare organisations.

Our review has some limitations. Firstly, the inductive approachto domain construction entailed interpretation. Papers that crossedboundarieswere assigned to a ‘leading domain’, so that cross-cuttingthemes, such as power, reoccur in various domains. Secondly, thedomain classification is contestable and, like any patterning, is one ofmany possible framings. Potential themes become submerged anddistributed. Policymaking, for example, is depicted within commu-nities of practice (e.g. Black, 2001), but more commonly withinevidence-based healthcare (e.g. Innvaer, Vist, Trommald, & Oxman,2002). Thirdly, segmentation between ‘generic’ and ‘health-related’

literatures is based on journal source rather than paper content,leading to debatable classifications at themargin. Fourthly, the Phase1 selection of journals is inevitably partial (although the Phase 2database search was designed to provide a safety-net).

Finally, what does this review add to our understanding of thiscomplex field? The title of the paper promised a ‘critical’ review, bydeveloping an interpretive understanding and overview. So wehave not simply and descriptively listedmany barriers and levers ofknowledge mobilisation but rather sought to identify, classify andcritique alternative social science perspectives: our focus is asmuchconceptual as empirical. It is also comparative between the variousschools identified. We have deliberately looked beyond healthcarein the search for new theoretical perspectives, especially relevant ifthe current healthcare field is becoming marketised ordeinstitutionalised.

We characterised an important evolution in the healthcareknowledge mobilisation literature. In the space of eight years(2000e2008) we observe a marked shift, described as an epistemo-logical turn. Hierarchical models of evidence, based on medicalauthority, have been challenged by qualitative and narrative forms,where the patient’s voice is louder. Constructs of knowledge mobi-lisation have shifted from linear to relational and organic (e.g.networks based on trust). The focus of our enquiry is knowledgemobilisation but this sweep of ideas reflects broader shifts. The vectorof simple to complex/contingent mirrors developments in widersocial science literature, increasingly drawing on paradigms such associal constructionism (Berger & Luckmann, 1966), identity theory(Giddens, 1991) and the negotiated enactment of innovations(Greenhalgh et al., 2004). We conjecture that the trajectory will shiftagain, through introduction of positive economic and strategicconcepts of knowledge. The resource based view will complementrelational theories of organisational form, andwill beweighedagainstsociological accounts of knowledge based on power and control.

Acknowledgement

The authors acknowledge the support of the UK National Insti-tute of Health Research Service Delivery and Organisation Pro-gramme. The views expressed are those of the authors and notnecessarily those of the NIHR SDO or the Department of Health.

Appendix. Supplementary material

Supplementary material associated with this article can befound, in the online version, at doi:10.1016/j.socscimed.2011.11.042.

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