the impact of organizational culture of knowledge …
TRANSCRIPT
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THE IMPACT OF ORGANIZATIONAL CULTURE OF KNOWLEDGE
TRANSFER PRACTICES: A CASE STUDY OF A HEALTH CARE
ORGANIZATION
Thesis submitted for the degree of
Doctor of Social Science
University of Leicester
by
Rania Nasir AlGhamdi
The School of Business
University of Leicester
November 2019
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The Impact of Organizational Culture on Knowledge Transfer Practices: A Case
Study of a Health Care Organization
By Rania AlGhamdi
Abstract
Knowledge transfer in organizations has been a topic of great interest to many
researchers in recent years. Most research studies related to knowledge transfer have
investigated the different aspects of organizational culture and how they influence the
process of knowledge transfer. However, there has been a lack of studies that examine the
relationship between organizational culture and knowledge transfer in health care
organizations in general and in developing countries such as Saudi Arabia in particular.
This research study is driven by the need to close the gap in the literature by examining
the relationship between organizational culture and knowledge transfer in the health care
sector in Saudi Arabia.
The aim of this research is to investigate the impact of organizational culture on the
transfer of knowledge in health care. Studies in this area have taken a holistic approach to
identify the factors that impact knowledge transfer. The present study takes a more
focused approach, where the cultural factors that impact the transfer of knowledge are
identified and explored through the lens of a health care organization. This research is set
within the context of health care in Saudi Arabia, two contexts which have not been
considered together in previous studies.
The aim of the study was achieved by conducting a case study in a health care
organization. The research methodology includes both positivist and interpretivist
approaches, utilizing a mixed research approach in which qualitative and quantitative
research approaches were implemented. Research data were collected using self-
administered online questionnaires and semi-structured interviews. The findings from the
questionnaires were later compared with the findings from the interviews.
The research concludes that the culture of an organization has both a facilitating and an
impeding effect on knowledge transfer in the context of a health care organization. One
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finding suggests that organizational management and communication are amongst the
main factors that have this facilitating and impeding impacts on the transfer of
knowledge. Second, meeting the needs of customers and patients is revealed to have the
most significant impact on organizational culture in health care. The research concludes
that a culture that is supportive of knowledge transfer depends on having both internal
and external motivational factors within the organization. The research outcomes have
academic implications, since the research findings can be compared with other Western
culture research findings, and practical implications for knowledge transfer practices and
communication strategies in health care organizations.
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Acknowledgements
I would like to take this opportunity to pay tribute to the people who have supported me
during my journey.
First and most importantly, I would like to extend my deepest gratitude and special
appreciation to my supervisor, Prof. John Goodwin, for his constant support, incredible
patience, and endless encouragement throughout my Doctorate journey. You are the best
and I am forever in your debt.
Second, I would like to thank my amazing parents (Lina and Nasir), my homies (Dyala,
Reema, and Mohammed), my husband (Majed), and my precious darlings (Lina and
Mohammed). Guys, thank you so much for your endless emotional support and for
always believing in me, even when I didn’t believe in myself… You made this happen.
Lastly, I am grateful for those who offered me encouraging words, listened to me
complain, checked up on me every now and then, provided technical support, and kept
me properly caffeinated all the time. Thank you all.
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Table of Contents
Abstract…………….. ...................................................................................................................... 2
Acknowledgements .......................................................................................................................... 4
List of Tables……….. ..................................................................................................................... 8
List of Figures………………………………………………………………………………..……9
Chapter 1: Introduction .............................................................................................................. 10
1.1 Research Background .............................................................................................................. 10
1.2 Purpose of the Research ........................................................................................................... 12
1.3 Research Questions .................................................................................................................. 12
1.4 Significance of the Research .................................................................................................... 13
1.5 Structure of the Thesis ............................................................................................................. 15
Chapter 2: Literature Review on Knowledge Transfer............................................................ 17
2.1 Introduction. ............................................................................................................................. 17
2.2 Defining Knowledge ................................................................................................................ 19
2.3 Classification of Knowledge .................................................................................................... 21
2.3.1 Tacit vs. Explicit Knowledge ................................................................................... 21
2.3.2 Individual vs. Organizational Knowledge ............................................................... 23
2.4 The Concept of Knowledge Transfer ....................................................................................... 24
2.4.1 Defining Knowledge Transfer ................................................................................. 24
2.4.2 Factors Affecting Knowledge Transfer.................................................................... 27
2.4.2.1 Individual Factors .................................................................................... 28
2.4.2.2 Technological Factors .............................................................................. 30
2.4.2.3 Organizational Factors ............................................................................. 30
2.4.3 Knowledge Transfer in Health Care ........................................................................ 32
Chapter 3: Literature Review on Organizational Culture ....................................................... 35
3.1 Introduction …………………………………………………………………………….……36
3.2 Defining Culture and Subculture ............................................................................................. 36
3.3 Understanding National Culture .............................................................................................. 38
3.4 The Concept of Organizational Culture ................................................................................... 42
3.5 Organizational Culture and Knowledge Transfer .................................................................... 45
3.6 An Overview of Saudi Arabia .................................................................................................. 46
3.6.1 Culture of Saudi Arabia ........................................................................................... 47
3.6.2 Health Care in Saudi Arabia ................................................................................... 49
3.7 Conclusion............................................................................................................................... 49
Chapter 4: Research Methodology ............................................................................................. 51
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4.1 Introduction ………………………………………………………………………………… 51
4.2 Research Scope ........................................................................................................................ 51
4.3 Research Philosophy ................................................................................................................ 52
4.4 Research Approach .................................................................................................................. 54
4.4.1 Quantitative Approach ............................................................................................. 56
4.4.2 Qualitative Approach ............................................................................................... 58
4.5 Research Setting....................................................................................................................... 59
4.6 Research Design and Phases .................................................................................................... 60
4.6.1 Phase One: Quantitative Research Approach .......................................................... 62
4.6.1.1 Sample Selection ...................................................................................... 62
4.6.1.2 Data Collection Approach........................................................................ 64
4.6.1.3 Questionnaire Design ............................................................................... 65
4.6.1.4 Pilot Survey.............................................................................................. 67
4.6.1.5 Research Implementation ........................................................................ 68
4.6.1.6 Data Analysis ........................................................................................... 69
4.6.1.7 Phase One Limitations ............................................................................. 70
4.6.2 Phase Two: Qualitative Research ............................................................................ 72
4.6.2.1 Sample Selection ...................................................................................... 72
4.6.2.2 Data Collection Approach........................................................................ 73
4.6.2.3 Designing the Interviews ......................................................................... 74
4.6.2.4 Pilot Testing ............................................................................................. 75
4.6.2.5 Research Implementation ........................................................................ 76
4.6.2.6 Data Analysis ........................................................................................... 77
4.6.2.7 Phase Two Limitations ............................................................................ 78
4.7 Ethical Considerations ............................................................................................................. 79
4.8 Discussion and Conclusion ...................................................................................................... 80
Chapter 5: Research Results and Discussion ............................................................................ 82
5.1 Introduction ………………………………………………………………………………….82
5.2 Phase One: Quantitative Research Results .............................................................................. 83
5.2.1 Research Respondents ............................................................................................. 83
5.2.2 Demographics .......................................................................................................... 83
5.2.2.1 Gender ...................................................................................................... 84
5.2.2.2 Nationality ............................................................................................... 84
5.2.2.3 Worked for Other Organizations ............................................................. 85
5.2.2.4 Number of Years of Experience in the Current Organization ................. 86
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5.2.2.5 Level of Education ................................................................................... 87
5.2.2.6 Work Location ......................................................................................... 87
5.2.2.7 Management Level .................................................................................. 88
5.2.3 Number of Reports ................................................................................................... 89
5.2.4 Transfer of the Organization Knowledge (Mission and Vision) .............................. 91
5.2.5 Attitude Towards Organizational Culture ................................................................ 94
5.2.6 Attending Educational Courses ................................................................................ 99
5.2.7 Satisfaction with Knowledge Transfer (KT) Practices .......................................... 100
5.2.8 Factors Affecting Knowledge Transfer.................................................................. 101
5.2.9 Knowledge Transfer Practices ............................................................................... 110
5.2.10 Factors Influencing the Significance and Choice of Knowledge Transfer Practice
115
5.3 Phase Two: Qualitative Research Results .............................................................................. 119
5.3.1 Research Respondents ........................................................................................... 119
5.3.2 Demographics ........................................................................................................ 119
5.3.3 Interview Findings ................................................................................................. 121
5.3.4 Organizational Culture ........................................................................................... 122
5.3.5 Organizational Factors that Affect Knowledge Transfer ....................................... 124
5.3.6 Knowledge Transfer............................................................................................... 126
5.3.7 Motivation to Transfer Knowledge ........................................................................ 130
5.3.8 Barriers to Knowledge Transfer ……...……………….………………………...128
5.4 Discussion and Conclusion .................................................................................................... 135
Chapter 6: Discussion and Conclusion .................................................................................... 141
6.1 Overview of the Research ...................................................................................................... 141
6.2 Introduction. ........................................................................................................................... 142
6.3 Practical Implications for Organizations................................................................................ 150
6.4 Research Contributions .......................................................................................................... 152
6.5 Limitations of the Research ................................................................................................... 153
6.6 Recommendations for Future Research ................................................................................. 155
References…… ........................................................................................................................... 157
Appendices....... ........................................................................................................................... 189
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List of Tables
Table
No.
Title Page
Number
5.1 Summary of the Research Respondents’ Demographic
Details (N=81)
83
5.2 Respondents’ Gender 84
5.3 Respondents’ Nationality 85
5.4 Worked for Other Organizations 86
5.5 Years of Experience in Current Organization 86
5.6 Respondent’ Highest Level of Education 87
5.7 Respondents’ Work Location 87
5.8 Respondents’ Management Level 88
5.9 Cross-tabulation of Management Level, highest Level of
Education, and Gender
88
5.10 Cross-tabulation between Management Level and Years
of Experience
89
5.11 Clarity of the Mission and Vision to the Respondents 92
5.12 Clarity of the Mission and Vision to the Subordinates 93
5.13 Reponses to Organizational Culture Statements 95
5.14 Attended Courses in the Last Three Months 99
5.15 Satisfaction with KT Practices 100
5.16 Cross-tabulation between satisfaction with KT Practices
and Management Level
100
5.17 Factors that Impact Knowledge Transfer 101
5.18 Knowledge Transfer Practices 110
5.19 Reponses to Knowledge Transfer Statements 111
5.20 Nature of Current Job 119
5.21 Number of Years in Health Care 120
5.22 Number of Years in Current Organization 120
5.23 Highest Education Qualification 120
5.24 Additional Qualifications in Current Organization 121
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List of Figures
Figure No. Title Page Number
5.1 Attitude Towards Organizational Culture 96
5.2 Attitude Towards Knowledge Transfer Practices 113
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Chapter 1: Introduction
Transferring Knowledge in Health Care
1.1 Research Background
This thesis explores the impact of organizational culture on knowledge transfer in the
health care sector in Saudi Arabia. The research is conducted through a case study
involving a health care organization in Saudi Arabia. The aim of the study is to highlight
the cultural factors in the organization that impact on the transfer of knowledge. By
identifying these aspects, health care organizations will be able to utilize their resources
more effectively. An extensive review of the literature suggests that most previous
studies employed either qualitative or quantitative research approaches to identify the
cultural factors in organizations that impact on knowledge transfer. This research study
utilizes the strengths of both qualitative and quantitative research methods and has
adopted a positivistic and interpretivist approach in the study design.
The number of studies on the impact of organizational culture on knowledge transfer
have increased in recent years owing to the surge in interest in globalization and the fast
changes that are taking place in organizations. Despite the many research contributions in
the fields of knowledge transfer and organizational management, there is still a lack of
understanding of how knowledge is transferred in the context of health care. This vacuum
has triggered the study’s main research question: What is the impact of organizational
culture on knowledge transfer practices in health care? This interest in knowledge
transfer emerges from the fact that knowledge has been identified as a significant source
of competitive advantage in organizations in today’s competitive and diverse
environment (Raguž, Zaken, & Peronja, 2017). For some organizations, the demand for
knowledge transfer even goes beyond the need to remain competitive in the business
market, so that knowledge transfer is a significant element of organizational existence in
the global market (Dorai, Farkas, Karoliny, & Poor, 2012).
Organizational culture has been identified as a factor that affects knowledge transfer
(Ladd& Heminer, 2002), in fact, it is crucial to the successful transfer of knowledge
within an organization. As such, organizational culture needs to be properly understood
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to ensure the effective transfer of knowledge. Organizational culture is impacted by the
national culture of the country in which the organization operates (Buchanan&
Huczynski, 2004), which includes values, beliefs, and customs (Jung, Su, Baeza & Hong,
2008). Therefore, to understand the culture of an organization, the national culture must
be explored and understood first.
For the purpose of this research study, the Saudi culture will be explored, as the
organization under study is situated in Saudi Arabia. Saudi Arabian culture can be
described as religious and generally conservative in nature. Islam is the official religion
in Saudi Arabia. The country of Saudi Arabia is at the center of the Islamic world, as the
two holy places of Makkah and Medina are located in Saudi Arabia. Religious values,
cultural norms, and social traditions play an essential part in Saudi culture. Islamic or
Sharia law applies to all aspects of the individual’s life and conduct, where the Holy
Quran is the source of Sharia law; the Saudi legal system must comply with Islamic law.
This suggests that Saudi Arabia is a country that has no strict separation between state
and religion, unlike countries such as the United States of America. Most research studies
have been conducted in Western countries, where there is a strict separation between state
and religion (Martin, 1992). Conducting research in countries such as Saudi Arabia that
do not have this separation will contribute to the organizational literature. This can be
achieved through a cross-comparison of research outcomes in different social and cultural
contexts.
Most researchers have successfully highlighted the strategic significance of knowledge
transfer in various organizations such as Bou-Llusar and Segaraa-Cipres (2006);
however, there is a lack of research on knowledge transfer in the health care sector.
Health care organizations should occupy center stage in the global market for their
commitment to delivering the highest standards of care to patients. With the continuous
changes in the global market and to remain competitive, health care organizations, like
other business entities, need to shift their attention from tangible resources to intangible
resources, such as intellectual capital (Sheng, Chang, Teo, Lin& 2013), which includes
medical knowledge. Health care organizations should consider the strategic significance
of transferring this medical knowledge. As such, medical knowledge can be considered
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an essential component of any health care organization, as it increases the organization’s
strategic competitiveness. Implementing effective knowledge transfer strategies is
significant in health care, as it enables organizations to achieve the highest standards of
excellence in patient care. Knowledge transfer can also be utilized by health care
organizations to address possible issues pertaining to patient care (Pentland, Forsyth,
MacIver, Walsh, Murray, Irvine & Sikora, 2011) and other issues related to health care.
1.2 Purpose of the Research
As suggested above, the aim of this research is to investigate the impact of organizational
culture on knowledge transfer in a health care organization in Saudi Arabia. There are
many research studies available on the topic of knowledge transfer; however, as
mentioned earlier, there are not that many studies on knowledge transfer in the context of
health care. Therefore, this research aims to contribute to the knowledge transfer
literature by investigating and explaining concepts and areas that are unexplored.
Based on the above, the objectives of this research study are threefold:
• To understand the impact of organizational culture on knowledge transfer in
health care. This encompasses examining the effects of organizational culture
factors and dimensions on the process of knowledge transfer in a health care
organization.
• To identify the most effective knowledge transfer mechanism utilized to transfer
significant strategic organizational knowledge, such as the mission and vision, to
the rest of the organization.
• To identify the factors that enable and impede knowledge transfer in health care
by investigating the effectiveness of various knowledge transfer practices
applicable in a health care organization.
1.3 Research Questions
The key research question to be addressed in this study is the following:
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What is the relationship between organizational culture attributes and knowledge
transfer in health care?
This question serves the research study’s main purpose, which is to explore the impact of
specific organizational culture factors on knowledge transfer in health care. The sub-
questions that influence this research study are the following:
• What are the organizational culture factors that affect the transfer of knowledge in
health care? This question is subsequent to the first research question. Identifying the
organizational culture dimensions and understanding their relationship with the
transfer of knowledge will assist in addressing the research question.
• Which mechanism is most effective when transferring critical organizational
knowledge such as the mission and vision? This research study intends to contribute
to the existing literature by exploring the various knowledge transfer practices
utilized in the organization to communicate significant and critical organizational
knowledge, such as the mission and vision, and subsequently identifying the most
effective methods to transfer knowledge in the context of health care.
• What are the most significant and least significant knowledge transfer practices in
health care? Considering organizational culture, this question aims to identify the
knowledge transfer practices available that are most and least important in health
care. This research question targets the transfer of knowledge between individuals,
teams, departments, and parent organizations, as opposed to the transfer of
strategically critical organizational knowledge, top-down, from upper management to
the rest of the organization.
1.4 Significance of the Research
Knowledge transfer as a research theme has flourished in recent years. An extensive
review of the literature indicates that there is a profusion of publications, resources,
frameworks, and models available on the topic of knowledge transfer. This interest has
gone beyond the traditional knowledge management literature. Some researchers have
contributed to the growing body of literature by pushing the research boundaries and
linking knowledge transfer with other disciplines and fields of study, such as information
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technology and management. However, despite this growing interest in knowledge
transfer, research studies pertaining to specific topics in knowledge transfer have been
scarce or even non-existent. Further research and investigation are needed to bridge some
of the knowledge gaps that currently exist in the knowledge transfer literature.
The present study is unique because of its research context. The research was conducted
in a health care organization within the cultural limitations of Saudi Arabia. This section
highlights some of these research gaps and how this study aims to contribute to the field
of knowledge transfer research by bridging these gaps.
The significance of this research study stems from the importance of knowledge as an
asset and knowledge transfer as a strategic tool in organizations. This might explain why
several studies have attempted to link various organizational attributes and outcomes with
knowledge transfer and to explore these relationships. Multiple studies have investigated
the effect of organizational culture on knowledge transfer.
These studies on knowledge transfer have been conducted in various organizations.
However, to date knowledge transfer in health care has not been explored extensively.
Only very few studies were found in the literature that explore the topic of knowledge
transfer in health care. The available research studies do not primarily address the issues
pertaining to knowledge transfer and do not explore the relationship between knowledge
transfer and other organizational attributes. Most of the research on knowledge transfer
has been conducted in Western countries; there is a significant lack of studies conducted
in the Middle East. After an extensive search on topics related to knowledge transfer in
the Arab world, it was concluded that there are not that many relevant studies on
knowledge transfer, especially in the context of health care.
As mentioned, studies pertaining to knowledge transfer in health care are limited, and no
research studies were found on knowledge transfer in the context of health care in the
Middle East. This research study will contribute to the body of knowledge by explaining
the importance of knowledge transfer in health care. It also provides insights for health
care organizations in Saudi Arabia on the significance of culture and how this impacts on
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organizational initiatives such as knowledge transfer and how this in turn determines the
success of an organization.
The research will assist in gaining a comprehensive understanding of the knowledge
transfer practices available in health care settings. It will identify the most effective and
least effective knowledge transfer mechanisms for achieving organizational goals. This
will lead to an improved comprehension of the issues that health care organizations face
when implementing knowledge transfer practices, by identifying the factors that hinder
and facilitate knowledge transfer.
1.5 Structure of the Thesis
This research includes the case study of a health care organization in Saudi Arabia. It
explores how the impact of organizational culture on knowledge transfer in the health
care sector in Saudi Arabia is continuously evolving. The structure of this research study
follows the objectives stated earlier, to investigate the impact of organizational culture on
knowledge transfer in health care in Saudi Arabia.
The thesis is divided into six chapters. The introductory chapter presents the research
objectives, aim, research questions, and contribution to knowledge. Following the
introductory chapter, are two literature review chapters, which provide the theoretical
framework of existing studies and views on the topics of knowledge transfer and
organizational culture. Chapter 3 also discusses the major issues and arguments around
the topics of organizational culture and knowledge transfer by presenting the various
viewpoints and approaches. The fourth chapter presents an in-depth analytical framework
and the methodology utilized in this research study, which employs both quantitative and
qualitative research methodologies. The research approaches adopted throughout the
study are discussed. Questionnaires were designed after an extensive literature review
and administered to managers of the health care organization. A total of 81 questionnaires
were collected and the responses from this survey were analyzed. Following the
collection of the questionnaires, semi-structured interviews were conducted based on the
feedback collected from the quantitative research. In the qualitative research, 10 semi-
structured, one-on-one interviews were conducted amongst a sample of participants from
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two departments in the health care organization. In the methodology chapter, the
epistemological concepts, research limitations, and ethical issues are also addressed. This
is followed by the research findings chapter, in which the collected data from both the
questionnaires and the interviews are analyzed and discussed, linking the findings to the
research question. The findings are predominantly intended to identify the factors that
influence and impede the knowledge transfer process and the various approaches to the
transfer of knowledge in health care. The last chapter presents the discussion and
conclusion, offering an overview of the central debates and the research findings. The
chapter includes a summary of the main issues emerging from the research and concludes
with a few recommendations for future research.
1.6 Conclusion
This introductory chapter has offered a background to this research, as well as the
purpose of this study. It outlined the research questions that guide this research study and
presented the significance and scope of the research. The next chapter discusses the
theoretical literature that shapes this research study by way of a comprehensive review of
the existing literature relating to organizational culture and the transfer of knowledge.
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Chapter 2: Literature Review on Knowledge Transfer
Transferring Knowledge in the Context of Health Care
2.1 Introduction
The overall aim of the literature review is to explore how organizational culture impacts
on knowledge transfer in a health care setting. The issue of knowledge transfer in a health
care setting in Saudi Arabia has not been explored fully and this research study represents
a contribution to the knowledge and addresses a significant gap in the knowledge transfer
and organizational culture literature. This research study therefore focuses on
investigating the organizational culture factors that impact on the transfer of knowledge
in the health care sector in Saudi Arabia. The main outcome of this review is to identify
the existing definitions and theories related to knowledge transfer in the context of health
care and identify how these relate to organizational culture in a culture-sensitive country
such as Saudi Arabia. The knowledge gained from the literature review is used as a basis
for the empirical section of the research.
The main issues and debates related to the transfer of knowledge are explored in this
chapter. As mentioned earlier, the issue of knowledge transfer in a health care setting has
not been explored fully and while such issues are related to the context or setting, other
major issues and factors that impact on knowledge transfer are related to the culture of
the organization and perhaps of the nation. These topics are considered throughout this
chapter, in addition to the investigation of different concepts and theories.
Organizations possess both formal knowledge (available in reports, processes, and
databases) and informal knowledge, embedded in the minds of their employees (Evans,
Brown & Baker, 2017). In health care organizations, knowledge can be found in daily
practices which are shared and utilized by the health care employees to provide quality
care to the patients (El Morr & Subercaze, 2010), which is the desired outcome in any
health care organization. The proper utilization of knowledge in organizations entails an
understanding of how it is transferred (Ansell, 2007).
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According to Riusala and Smale (2007), the existence of health care organizations can be
attributed to the internalization of intangible resources through the transfer of knowledge.
Therefore, it is important to understand knowledge and its transfer in organizations, as it
is considered a key factor in the operation and development of health care organizations
worldwide, particularly in Saudi Arabia, where the health care sector is constantly
evolving.
The process of knowledge transfer requires an optimal setting and specific crucial
organizational attributes to occur (Ekore, 2014). Choi and Lee (2000) have identified
organizational culture as one of the key attributes. “Organization culture” refers to a
collection of the experiences, behaviors, values, and norms that are shared by individuals
in an organization (Ekore, 2014). This research study explores the organizational culture
factors that impact on knowledge transfer.
Knowledge and its classification should be properly understood prior to discussing the
various factors pertaining to knowledge transfer in organizations, especially in a health
care setting. In addition, the culture of the organization and the country as a whole need
to be discussed and taken into consideration when investigating the factors that impact on
knowledge transfer. This chapter offers a review of the existing literature that discusses
the different factors that impact on the transfer of knowledge in organizations. This
section analyzes the different components of organizational and national culture and their
impact on knowledge transfer in health care.
While this study adds to the wider body of theoretical and empirical literature pertaining
to knowledge transfer, this research focuses on the impact of organizational culture on the
transfer of knowledge in health care organizations. This study aims to identify the
organizational culture attributes that facilitate and impede knowledge transfer in health
care. As mentioned, this chapter examines the theoretical framework and the literature on
knowledge transfer, with an emphasis on health care, to identify the research gap that can
be addressed by answering the following research questions:
• What are the organizational culture factors that affect the transfer of knowledge in
health care?
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• Which mechanism is most effective when transferring critical organizational
knowledge such as the mission and vision during?
• What are the most significant and least significant knowledge transfer practices in
health care?
The literature review is organized into two main sections based on the research study’s
key concepts, namely knowledge transfer and organizational culture. This chapter
presents the theoretical framework and a comprehensive literature review on the concept
of knowledge transfer, thereby laying the necessary basis for developing the research
study’s framework. The first section explores the various definitions and classification of
knowledge. The concept of organizational knowledge is also discussed, as it relates to
knowledge transfer and the research study. Next, the concept of knowledge transfer and
its conceptual models are discussed. Then, the factors that impact knowledge transfer are
presented, with the emphasis on organizational culture factors. The last section reviews
the literature on knowledge transfer in the context of health care. The next chapter
focuses on the concepts of organizational culture and provides a brief overview of Saudi
Arabia as a research context.
2.2 Defining Knowledge
This section presents some viewpoints and perceptions on the definition of knowledge,
which is one of the core elements in knowledge transfer. For many years, the concept of
knowledge has been studied from several perspectives in various contexts (Randeree,
2006). Researchers have argued about how to conceptualize knowledge and how to
interpret its meanings (Roth, 2003). Zander and Kogut (1995) have defined knowledge as
information, skills, and competencies, whilst Nonaka and Takeuchi (1995) have
conceptualized knowledge as an element of making. Some view knowledge as the result
of experience and practice (Schubert, Lincke & Schmid, 1998), while others
conceptualize knowledge as a personal state of retaining information that resides in the
human mind and thoughts (Nonaka, 1994). Despite the various understandings of
knowledge, the act of knowing and the concept of knowledge will almost always be
incomplete and impartial (CLMS, 2004) and will remain ambiguous (Schneider, 2007).
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These varied definitions of knowledge call for re-evaluating the understandings and
implications of all concepts related to knowledge.
Knowledge is classified using various methods, for example, Roth (2003) believes that
knowledge exists at different levels, which include individual, group, and organizational
levels. Yet, the preferred method that scholars generally use to categorize knowledge is
as proposed by Nonaka (1994), where knowledge is classified into two categories:
explicit knowledge and tacit knowledge. A great deal of emphasis has been placed on the
difference between tacit and explicit knowledge (Nonaka& Takechi, 1995), as it affects
the choice of knowledge transfer methods. The different forms of knowledge are
presented in the next section.
It is also important to distinguish “knowledge” from “data” and “information”. Research
suggests that there are various ways to define data, information, and knowledge. Despite
all existing research, an accurate understanding of what data, information, and knowledge
are and the relationships among them remain vague and unclear (Liew, 2007). As
mentioned, various perspectives exist on the meanings of data, information, and
knowledge. Bhatt (2001), for example, views data as raw facts, while Liew (2007)
considers information as messages that hold significant meaning for a specific action.
Randeree, (2006) perceives knowledge as information retained in the human mind. The
knowledge management literature suggests that combined data produces information and
combined information produces knowledge (Alavi & Leidner, 2001). McDermott (1999)
has outlined the main features of knowledge that differentiate it from information:
“Knowledge is a human act, the residue of thinking, created in the present moment,
belongs to communities, circulates through communities in many ways, and new
knowledge is created at the boundaries of old” (p. 105).
Bhatt (2001) has proposed that knowledge is the assembly of structured data, supported
by a collection of principles, procedures, and processes. Bhatt (2001) has explained that
information or data could be converted to knowledge only when meaning is added and
incorporated. Accordingly, the main element to consider when discussing knowledge and
information is the added purpose or meaning (Bhatt, 2001).
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It is clear that the definition of knowledge varies depending on the meaning attached to it
by the individual and the way knowledge is expressed depends on the knowledge
source’s interpretation and the intended meaning. Knowledge is linked to human
cognition, and managing this knowledge occurs in a structured and complex social
context (Thomas, Kellogg & Erickson, 2001). Knowledge also depends on the context in
which it is placed, so that the meaning is interpreted differently in various paradigms
(Marakas, 1999). This association of meaning with knowledge and the recognition of
knowledge as existing in the knowledge source’s mind support the notion that
“knowledge is highly personal,” as described by Nonaka (1991, p. 98), specifically tacit
knowledge.
2.3 Classification of Knowledge
It is important to identify the different types and classifications of knowledge prior to
discussing knowledge transfer in organizations. The next section outlines the different
categories of knowledge.
2.3.1 Tacit versus Explicit Knowledge
The method that most scholars use to categorize knowledge has been proposed by
Nonaka and Takeuchi (1995), who have classified knowledge into two categories:
explicit knowledge and tacit knowledge. A great deal of emphasis has been placed on the
difference between tacit and explicit knowledge (Nonaka & Takeuchi, 1995). This
distinction is crucial when choosing an appropriate knowledge transfer approach.
On the one hand, explicit knowledge is objective, formal (Ehin, 2008), and encoded in
words and numbers (Olomolaiye & Egbu, 2005). This type of knowledge can easily be
encoded and transferred (Kumar & Ganesh, 2009), as it is transmitted in formal and
structured language and contained in records and documents. As such, explicit
knowledge can be transmitted via technology and information systems (Martensson,
2000).
On the other hand, tacit knowledge is subjective and embedded in the minds of
individuals (Nonaka & Takeuchi, 1995), which makes it challenging to transfer (Chen &
22
Mohamed, 2010). Tacit knowledge is highly personal and individual (Polanyi, 1958).
Mohamed, Stankosky, and Murray (2006) have stated that tacit knowledge is “the
personal knowledge used by individuals to perform their work and to make sense of their
world” (p. 106). This type of knowledge can be gained through continuous interaction
with people (Ehin, 2008), practice, and years of experience and expertise (Jasimuddin,
Klein, & Connel, 2005). Nonaka (1994) agrees with this notion and has added that tacit
knowledge is “deeply rooted in action, commitment and involvement in a specific
context” (p. 16). As such, tacit knowledge is more complex and difficult to attain and
transfer than explicit knowledge; this might explain why tacit knowledge has attracted
more research consideration than explicit knowledge.
Despite the difference between tacit and explicit knowledge, the two types of knowledge
complement each other and their interaction results in knowledge conversion (Alkhaldi &
Olaimat, 2006). Nonaka and Takeuchi (1995) have offered the broadly cited
socialization, externalization, combination, and internalization (SECI) model of
knowledge creation. This model describes the creation of knowledge by processes of
knowledge enhancement, as created by individuals, and transforming knowledge from
one form to the other through four modes: socialization, externalization, combination,
and internalization (Ragab & Arisha, 216). The four modes of knowledge conversion, as
explained by Nonaka and Takeuchi (1995), are the following:
• Explicit to tacit (internalization): knowledge is usually absorbed and understood
by the individual. This mode can be seen in on-the-job training.
• Tacit to explicit (externalization): knowledge can be transformed into explicit
knowledge through externalization, articulation, and translation. In this process,
the knowledge in the individual’s mind is articulated into concepts that can be
explored.
• Tacit to tacit (socialization): in the process of socialization, knowledge is captured
and delivered to the others through direct social interaction. A good example of
this is when employees interact together within an organization or outside the
organization with consultants. Another example is informal mentoring programs
implemented in organizations.
23
• Explicit to explicit (combination): this process is frequently concerned with
conveying knowledge through documents, guidelines, and emails. In this process,
the utilization of information systems can be beneficial, through which knowledge
can be easily disseminated and transferred across an organization.
2.3.2 Individual versus Organizational Knowledge
In addition to the classification based on the nature of knowledge, knowledge can also be
categorized as organizational or individual knowledge. This classification is particularly
important, as it relates to the present research study.
Individual knowledge is a component of an organization’s knowledge that is embedded
in the minds of individuals (Lam, 2000). Organizational knowledge is a combination of
all the knowledge and experiences of all the employees of an organization and is mainly
the possession of the organization (Jones & Leonard, 2009). Organizational knowledge
can be considered a collection of individual knowledge (Song & Chermack, 2008).
Therefore, it is important for the management of organizations to encourage employees
to share and transfer their individual knowledge, perhaps through communities of
practice, to add and contribute to organizational knowledge (Bhatt, 2001). According to
Ragab and Arisha (2016), an intricate active relationship exists between individual and
organizational knowledge, in which individual knowledge can be converted to
organizational knowledge, as illustrated in the SECI model by Nonaka and Takeuchi
(1995) discussed in the previous section of this chapter.
It is crucial to understand the types of organizational knowledge as these apply to this
research. According to Fei, Chen, and Chen (2009), organizational knowledge can be
classified into explicit and tacit knowledge. Below both types are described, as explained
by Fei et al. (2009):
Organizational explicit knowledge includes:
• Information technologies that can be categorized into three categories: a.
knowledge storage systems, which assist managers in making decisions and
enable employee development, b. knowledge-retrieval systems, which allow
24
access to existing knowledge such as intranets, and c. knowledge communication
systems, which enable knowledge transfer and sharing, such as e-forums and
online communities of practice.
• Operational manuals that are instructions or workplace operational procedures
that provide how-to instructions.
• Intellectual properties, such as patents, copyrights and trademarks.
Organizational tacit knowledge includes:
• Culture: this is an important factor of organizational knowledge, as it includes the
vision and mission statement. This will be discussed in detail in subsequent
sections, in which its relation to knowledge transfer in organizations is explored.
• Image: this is known as organizational or corporate social responsibilities
(CSRs).
• External relationships: these include the organization’s external relations with
other organizations and alliances.
2.4 The Concept of Knowledge Transfer
This section defines knowledge transfer as one of the core concepts of this research study
and discusses various topics in relation to the knowledge transfer literature.
2.4.1 Defining Knowledge Transfer
There is no one uniform definition of knowledge transfer. Each researcher has
conceptualized knowledge transfer in a specific way or from a specific perspective,
resulting in various definitions that differ in both their level of complexity and scope
(Feet& Naess, 2015). Some researchers have conceptualized knowledge transfer as a
process and knowledge as an experience, for example Argote and Ingram (2000), who
have referred to: “the process through which one unit (e.g. group, department, or
division) is affected by the experience of another” (p. 151). Szulanski (2000) has focused
on the knowledge recipient in his definition of knowledge transfer: “Knowledge transfer
is seen as a process in which an organization recreates and maintains a complex, causally
ambiguous set of routines in a new setting” (p. 10). This definition refers to inter-
25
organizational knowledge transfer, in which knowledge is transferred between
organizations, while intra-organizational “manifests itself through changes in knowledge
or performance of the recipient unit” (Inkpen & Tsang, 2005, p. 149). Knowledge
transfer can occur in various settings (AlJawi, 2009). Despite geographical limitations,
knowledge can be transferred across cultural, organizational, and national borders to
reach individuals and multinational organizations (Lin, Geng, & Whinston, 2005). Darr
and Kurtzberg (2000) have perceived knowledge transfer as an event and explained that
“Knowledge transfer is conceived as an event through which one organization learns
from the experience of another” (p. 29). Feet and Naess (2015) have described
knowledge transfer as “the movement, adoption, and retention of knowledge between
organizational entities” (p. 13). This definition suggests that knowledge transfer is a
multifaceted process that involves more than simply “moving” knowledge between
entities, but also incorporates several other processes that enable the utilization of
knowledge within organizations.
Knowledge transfer is considered a complex process, as suggested by Benito-Bilbao,
Sánchez-Fuente, and Otegi-Olaso (2015). It encompasses the interaction of three factors:
process, people, and technology, in which people constitute the most important factor
(Shahmoradi, Reza Safadari & Jimma, 2017). The technology component is considered a
hard factor and the soft factors include people and the various processes (Mason &
Pauleen, 2003). A certain balance between the hard and soft factors is required to
facilitate the knowledge transfer process (Goh, 2002) and ensure its successful
implementation (Arntzen-Bechina & Leguy, 2007). Organizations need to consider all
three components when developing their knowledge transfer strategies.
Knowledge transfer processes can be categorized into two types: structured and
unstructured processes (Nidhra & Yanamadala, 2012). Structured knowledge transfer is
planned and formal, whilst unstructured knowledge transfer is unplanned and informal
(Chen & McQueen, 2010). Organizations utilize both types of knowledge transfer
processes to transfer knowledge to individuals or groups across the organizations.
According to Szulanski (1996), the structured knowledge transfer process is comprised of
four stages: initiation (search), implementation (learning), ramp-up (practice), and
26
integration (grasp). The unstructured knowledge transfer process consists of the elements
as structured knowledge transfer, but these do not occur in the same order (Chen &
McQueen, 2010).
In the knowledge transfer process, the type of knowledge (tacit or explicit) needs to be
taken into consideration. Understanding both forms of knowledge is essential for the
effectiveness and proper selection of the knowledge transfer mechanism: the form of
knowledge must match the selected knowledge transfer method (Goh, 2002). The
knowledge transfer processes of tacit and explicit knowledge differ in terms of the
modes, speed, and mechanisms (Park, Vertinsky & Becerra, 2015). As mentioned earlier,
on the one hand, tacit knowledge is usually complex, unique, and difficult to identify,
capture, codify, and transmit (Kabir & Carayannis, 2013). It is transferred mainly through
interpersonal contact (Davenport & Prusak, 1998) and less formal activities, such as
social interactions, (Goh, 2002), face-to-face communication (Nonaka & Takeuchi,
1995), communities of practice, and mentoring (DeLong, 2004). On the other hand,
explicit knowledge is easily codified and transferred in the workplace (Chilton &
Bloodgood, 2007) and does not require full interaction between the knowledge holder
and the recipient (Park, Vertinsky & Becerra, 2015). It is transferred through more
structured, formal, technology-based practices, such as information systems (Hansen,
Nohria & Tiemey, 1999).
Knowledge and its transfer are considered significant concepts in organizations and the
knowledge management literature, which can be attributed to their role in maintaining an
organization’s competitive advantage (Argote & Ingram, 2000; Nielson, 2010),
performance (Martinez-Noya, Garcia-Canal, & Guillen, 2013), and organizational
survival (Baum & Ingram, 1998). The transfer of knowledge improves the capability of
the organization, as it enables innovation (Nonaka & Takeuchi, 1995). Knowledge
transfer leads to employee commitment to the organization, as it helps in the employee’s
personal and professional development, which has a positive impact on the organization
(Cruz, Perez, & Cantero, 2009). In addition, knowledge transfer preserves organizational
knowledge and prevents its loss by ensuring that knowledge is effectively transferred and
available within the organization. To ensure the successful implementation and utilization
27
of knowledge in an organization, it is important to identify and understand the factors that
impact its transfer. It is also critical to understand the factors that impact on knowledge
transfer depending on the context of the organization (Cranefield & Yoong, 2005); in this
research study the focus will be on the health care context. The next section discusses the
factors that affect knowledge transfer.
2.4.2 Factors Affecting Knowledge Transfer
Effective knowledge transfer is an important pursuit for organizations to gain competitive
advantage, enhance performance (Susanty, Handayani & Henrawan, 2012), and ensure
organizational survival (Baum & Ingram, 1998) in the competitive global market. If
implemented accurately, knowledge transfer can help improve organizational
performance and assist in gaining a competitive advantage (Susanty et al., 2012).
Therefore, it is important for organizations to identify the factors that affect knowledge
transfer. Various studies are available in the knowledge management literature that
identify the factors that influence the transfer of knowledge within organizations.
Szulanski (2000) has identified four factors that affect knowledge transfer, namely the
knowledge source, the characteristics of the knowledge recipient, the knowledge transfer
context, and the knowledge being transferred.
Factors that impact the knowledge transfer process can be identified as being either
barriers or drivers. Factors that have a positive influence on knowledge transfer are
considered as drivers or enablers and factors that negatively impacts on the knowledge
transfer process can be labeled as hinders or barriers. Choi and Lee (2000) have identified
some organizational factors that are knowledge transfer enablers, including
organizational culture, organizational performance, organizational strategy, training, and
IT. To identify the driving and hindering factors, an understanding of the needs,
problems, and procedures of an effective knowledge management process is required
(Okere, 2017).
After a broad review of the existing literature, three main types of factors were identified,
namely individual factors, technological factors, and organizational factors. These factors
are discussed in more detail in the following sections.
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2.4.2.1 Individual Factors
Communication is considered the heart of the knowledge transfer process (Schwartz,
2007). Employees who communicate regularly are expected to share knowledge more
than employees who do not (Reagans & McEvily, 2003). This suggests that conducting
frequent meetings in organizations increases the probability of knowledge transfer
between employees. Communication affects interpersonal relationships and a good
relationship enables effective communication (Patricia, 2015). This suggests that
communication and interpersonal relationships are interconnected. The strength of an
interpersonal relationship affects the ease of knowledge transfer (Szulanski, 1996).
Knowledge transfer is more likely to occur when there is emotional closeness and the
communication frequency is high (Reagans & McEvily, 2003).
Based on the above, the relationship between the knowledge source and the recipient is a
factor that should be considered when transferring knowledge. Wilkesmann,
Wilkesmann, and Virgillito (2009) have explained that knowledge transfer includes two
processes: one providing the knowledge by an individual (the knowledge source) and the
other obtaining the knowledge by another individual (the knowledge receiver). Having a
good relationship between the knowledge source and the knowledge recipient is an
important factor to consider when transferring knowledge within or outside an
organization (Cummings & Teng, 2003). Not many studies have been conducted that
investigate the relationship between the knowledge provider and the receiver in a virtual
setting and across social, cultural, or organizational boundaries as it applies to knowledge
transfer. Ease of communication between the knowledge provider and the recipient is
important for the effectiveness of the knowledge transfer process (Szulanski, 1996). A
strained relationship between the knowledge provider and the receiver would hinder the
communication and negatively impact the transfer of knowledge (Szulanski, 1996;
Szulanski & Cappetta, 2003). Social cohesion eases the knowledge transfer process
(Reagans & McEvily, 2003). However, maintaining cohesion amongst individuals with
different backgrounds and information is a challenge when transferring knowledge
(Nidhra et al., 2013). This is particularly true when new hires or novice employees join a
29
group or team. If this situation is not managed carefully, this could hinder the knowledge
transfer process.
Studies have been conducted that explain the importance of cross-linguistic language to
communication (Schomaker& Zaheer, 2014). One of the most significant factors that
affect knowledge transfer is the communication language (Larsson & Ostberg, 2009).
English is the official business language in organizations, and this includes Saudi Arabia.
Language is an apparent contextual variance and misunderstandings by individuals are
likely to occur when communicating in a non-native language (Schomaker & Zaheer,
2014). Communication can be perceived as a barrier for some employees in organizations
that consider English as the official business communication language and where
communication is expected to be solely in English. This is considered a challenge that
some organizations face when transferring knowledge between their employees. In such
situations, knowledge sharing is restricted due to the lack of a common language (Carlile,
2004).
Motivation is the most researched factor in the field of knowledge management
(Kankanhalli, Tan & Kwok-Kee, 2005) and is considered one of the elements that
facilitate the transfer of knowledge in organizations (Cruz et al., 2009). Motivation refers
to the willingness to perform a task and can either be intrinsic (internal reward or
altruistic) or extrinsic (external reward such as monetary compensation). In knowledge
transfer, motivation is the willingness to transfer acquired knowledge to others within an
organization (Bock, Zmund & Kim, 2005). Employees might be willing to transfer
knowledge for various reasons, some extrinsic and others intrinsic. Cruz et al. (2009)
confirm that extrinsic motivation is not important in knowledge transfer, but the process
is enhanced through intrinsic motivation. It is important to consider both intrinsic and
extrinsic motivation factors when developing a knowledge transfer program in
organizations, as these factors might result in a more effective knowledge transfer
process.
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2.4.2.2 Technological Factors
Technology is one of the factors that facilitate the knowledge transfer process (Spender,
1996). Technology factors ensure that knowledge is transferred faster within an
organization and to a larger number of employees (Susanty et al., 2012), despite their
geographic location. However, the effectiveness of the technology for the process
depends on the type of knowledge being transferred, that is, whether it is tacit or explicit
(Fei et al., 2009). It would be beneficial to consider both types of knowledge when
selecting the technological tool to be utilized for the knowledge transfer process.
Information technology is mainly utilized for capturing, coding, storing, retrieving, and
distributing explicit knowledge (Susanty et al., 2012). Technology tools are also utilized
to form networks and facilitate the creation of online communities of practice, in which
employees can gather online and share knowledge (Lai, Pratt, Anderson, & Stigter,
2006). As such, ensuring that employees have access to the various information
technology tools available, such as online databases and the organization’s intranet, is
important to ensure the effective transfer of both tacit and explicit knowledge and retrieve
required knowledge within an organization.
2.4.2.3 Organizational Factors
This section presents the key organizational factors that impact the knowledge transfer
process within organizations. These factors include organizational strategy,
organizational structure and management, organizational performance, and organizational
culture.
Organizational strategy is one of the components of organizational success and survival,
as it defines an organization’s long-term goals and how to achieve them (Kipley &
Lewis, 2011). Organizational strategy considers the actions, programs, and efforts to
enhance the organization’s outcomes (Ekore, 2014). Some organizations might consider
learning and knowledge acquisition as part of their organizational strategy (Ekore, 2014).
Not many studies are available on the influence of organizational strategy on knowledge
management (Watkins & Marsick, 1996) and knowledge transfer.
31
Organizational structure is an important organizational factor in knowledge management
(Gold, Malhotra& Segars, 2000), as it influences knowledge transfer by determining the
flow of knowledge within organizations (Moyo, 2015). Two types of organizational
structures have been identified, namely a formal hierarchical structure and an informal
lateral structure, and both have major impacts on knowledge transfer within units (Tsai,
2002). Managerial hierarchy depends on the organizational structure and management
can be divided into three levels: top-level management / corporate suite (C-Suite),
middle-level management (mid-management), and lower-level management (Steiger,
Hammou & Galib, 2014). These management levels differ in terms of their roles and
levels of authority, power, and decision-making (Rezvani, 2017). Organizational
management plays a significant role in facilitating knowledge transfer in organizations,
by providing incentives to employees for knowledge transfer initiatives and through
incorporating learning and knowledge transfer in the organization’s mission, vision
statement, and strategy (Von Krogh, 1998). Management can facilitate the process of
knowledge transfer by ensuring that knowledge is accessible and available to all
employees within the organization.
Organizational performance is of particular importance in knowledge management, as it
is a reflection of organizational effectiveness (Ekore, 2014). Organizational performance
is considered a significant factor in knowledge transfer and knowledge management
practices (Hwang, 2003). Alony, Jones and Whymark (2007) have supported this by
stating that there is a strong relationship between organizational performance and
knowledge transfer. Choi and Lee (2000) have concurred by arguing that organizational
performance is an enabler for knowledge transfer. However, Ekore (2014) has disagreed
with this notion and explained that the difference in findings may be attributed to the
difference in the research settings.
Organizational culture is one of the organizational factors that influence knowledge
transfer (Abd Rahman & Shoid, 2017). It refers to the set of norms, attitudes,
experiences, values, and beliefs shared by individuals within an organization (Ekore,
2014). There are multiple definitions of the concept of organizational culture.
Organizational culture influences the way individuals interact with each other within an
32
organization, as well as the outcomes of an organization (Bingol, Sener & Cevik, 2013).
The culture of an organization is important, as it is considered a source of competitive
advantage in organizations (Barney, 1991) and an important element of organizational
effectiveness (Denison, 1990). Organizational culture is discussed in more detail in the
next chapter. Bogdanowics (2015) has provided a comprehensive explanation of the
significance of organizational culture by stating that “organizational culture aligned with
a strategy is the inner strength of the organization, significantly improving its
competitiveness. One of the most important elements in the process of change is the
correct diagnosis of the difference between the current and the desired cultural
characteristics” (p. 1).
2.4.3 Knowledge Transfer in Health Care
Knowledge transfer and exchange strategies are increasingly utilized to address
commonly encountered challenges of health care systems (Pentland et al., 2011). The
interest in knowledge transfer has increased in recent years. Knowledge transfer can be
considered an integral part of any organization, in any industry, and the health care
industry is no exception. Multiple studies have investigated knowledge transfer in
organizations; however, research on knowledge transfer in health care is limited. There is
a need to expand the research boundaries and explore knowledge transfer in organizations
in the context of health care. Knowledge transfer has gained importance in health care
organizations due to the recent demand and incorporation of technology in health care,
such as the addition of medical instrumentation, the introduction of health information
systems, and the automation of several processes (Calman, Kitson, & Hauser, 2007).
Therefore, employees working in health care organizations need to transfer their
knowledge, which will assist in improving the quality of health care services and enable
organizations to adapt to new technologies and practices (Jabr, 2007).
In health care organizations, knowledge is considered a significant asset and day-to-day
operations depend on the knowledge of the employees (Alvesson, 2004). Knowledge in
health care organizations includes medical and non-medical and tacit and explicit. Tacit
knowledge of health care practitioners is expressed in terms of clinical experience and
33
problem-solving skills. Health care explicit knowledge is captured and available in
medical records, patient records, guidelines, and health care forms and documents. Other
forms of knowledge in health care include patients’ education and social learning such as
communities of practice and medical/ clinical committees that exchange patient cases and
clinical knowledge.
Sibte and Abidi (2007) have identified the below types of health care knowledge:
1. Patient knowledge: includes a description of the patients’ health status.
2. Practitioner knowledge: is practitioners’ tacit knowledge and acquired through
experiences.
3. Medical knowledge: is the foundation of the knowledge domain that includes the
health care system, model, and processes.
4. Resource knowledge: is the health care resources and infrastructure within the
health care setting such as medical devices, tools, medications, support staff,
nurses, and facilities.
5. Process knowledge: includes health care pathways that define the health care
discourse for medical conditions to treat a patient.
6. Organizational knowledge: is the organizational policies, structure, information,
and knowledge flow in the health care organization.
7. Relationship knowledge: includes the social capital within an organization and the
communication process between various departments to enable the distribution of
patient information.
8. Measurement knowledge: entails the metrics and standards utilized in health care
organizations to measure the success of a health care delivery system and the
outcomes.
Research on health care knowledge and experience is scarce; however, most of the
researches accomplished in the context of health care is on the tacit knowledge,
experiences, skills, and attitudes of nurses who aim to provide better patients experience
and health care services. The major challenge of knowledge management in nursing is to
transfer tacit knowledge (Dehghani, Ganjoo, Basirian-Jahromi, Akhundzadeh, & Ganjoo,
34
2013). Experienced nurses with years of accumulated skills and knowledge of the
hospital processes and systems can be recorded in knowledge repositories, which adds to
the organization’s knowledge.
Jih, Chen and Chen (2008) conducted a research on knowledge structures and variables in
hospitals in Thailand, in which the main research objective was to investigate the effects
of these variables on each other in a health care setting. This research concluded that
there was a substantial relationship between knowledge characteristics (tacit or explicit,
and its complexity) and knowledge transfer strategies.
Health care knowledge is important in medical decision-making through assessing the
patients’ health and determining the appropriate treatment (Sibte& Abidi, 2007).
Knowledge is only valuable if properly captured, utilized and transferred (Jabr, 2007).
Medical knowledge is critical, complex, and complicated and requires special approaches
to capture, utilize, and transfer. Tailoring knowledge transfer to a specific audience, for
example, physicians, has proven to be beneficial (Pyra, 2003). This includes customizing
the format and delivery method to a specific audience (physicians) or circumstance
(health care organizations), as suggested by Conklin and Stolee (2008). This practice
helps increase the value of the knowledge resource (Dobbins, DeCorby & Twiddy, 2004).
It is the responsibility of the management in health care organizations to provide the
necessary tools and establish the most appropriate mechanisms to enable knowledge
transfer.
It is essential to identify the factors to an effective knowledge transfer strategy.
Researchers have identified various factors that impact the transfer of knowledge.
According to Dehghani et al. (2013), all researchers concur that the most significant
factors that affect the transfer of tacit knowledge are personal, organizational, and
technological barriers. Identifying these factors is important in implementing a successful
knowledge management plan in organizations (Joia & Lemos, 2010). Identifying the
knowledge transfer obstacles and determining the appropriate approaches to transfer
knowledge is critical in improving the knowledge and services. Developing a knowledge
transfer plan or strategy in health care organizations can result in the improvement of
organizational knowledge and maintain their competitive advantage (Dehghani et al.,
35
2013). Dobbins, DeCorby & Twiddy, (2004) identified lack of time as a barrier and
attempted to address this issue through incorporating the following concepts into their
knowledge transfer strategies, such as “credibility, quality of research, timeliness,
reliability, customizability, applicability, accessibility, electronic linkages, and
knowledge management” (p.4). Dobbins et al., (2004) have also highlighted the
significance of continuing professional training and development and consulting with
potential users (such as patients) in developing effective knowledge transfer strategies.
Transferring medical knowledge in health care organizations is considered of the utmost
importance, as the general welfare of the patient is the main goal of any health care
establishment. Knowledge is only valuable if properly captured, utilized and transferred
(Jabr, 2007). Medical knowledge is critical, complex, and complicated and requires
special approaches to capture, utilize, and transfer. Tailoring knowledge transfer to a
specific audience, for example physicians, has proven to be beneficial (Pyra, 2003). This
includes customizing the format and delivery method to a specific audience (physicians)
or circumstance (health care organizations), as suggested by Conklin and Stolee (2008).
This practice helps increase the value of the knowledge resource (Dobbins et al., 2004). It
is the responsibility of the management in health care organizations to provide the
necessary tools and establish the most appropriate mechanisms to enable knowledge
transfer. Unfortunately, Dobbins et al. (2004) didn’t provide information related to
specific characteristics of the health care sector that affect knowledge transfer.
36
Chapter 3: Literature Review on Organizational Culture
Organizational Culture: A Concept Worth Exploring
3.1 Introduction
The previous chapter explored the concepts of knowledge and knowledge transfer. It also
outlined the theoretical framework related to various mechanisms of transferring
knowledge and the factors that influence the process of knowledge transfer, with an
emphasis on health care organizations. This chapter also presents a literature review;
however, the focus here is on the concept of organizational culture. This study is
expected to extend the existing knowledge on the topic of knowledge transfer and add to
the understanding of the process by exploring it in the context of health care in a
conservative country such as Saudi Arabia.
This chapter discusses the notion of organizational culture by exploring the development
of the conceptual framework of organizational culture. The chapter starts by outlining the
various definitions of culture and subcultures in research and then examines the concept
of national culture. Discussing the different cultural paradigms and the various views on
national culture will add to the understanding of organizational culture. The next section
discusses the different definitions of organizational culture in the literature and how
organizational culture is informed by national culture. Then an overview of Saudi Arabia
and its unique social-cultural characteristics are presented, as well as the impact of its
culture and subcultures on organizations, specifically in a health care setting. The chapter
concludes by discussing the relationship between organizational culture and knowledge
transfer.
3.2 Defining Culture and Subculture
There is no universally accepted definition of the word “culture” (Bishop, Felstead,
Fuller, Jewson, Lee & Unwin, 2006). “Culture” is difficult to define, and various
meanings and definitions are provided in the literature (Nguyen, 2014). Most researchers
agree that culture consists of a meanings, values, and beliefs. Schwartz (2006), for
example, has defined culture as “the rich complex of meanings, beliefs, practices,
37
symbols, norms, and values prevalent among people in a society” (p. 138). Gill (2013)
has concurred by explaining that culture is a set of factors that are shared by a specific
group and that some of these factors include knowledge, ideas, values, beliefs, norms,
and attitudes. Hofstede (1997) has argued that values are the key element of any culture.
Culture can be demonstrated at multiple levels, from a small group to an organization
(Nguyen, 2014). Therefore, understanding the notion of culture is significant in studying
organizations, as it holds organizations together and influences organizational actions,
decisions, and directions (Tharp, 2009). Tharp has explained that an organization’s
dominant values, beliefs, and attitudes or culture permeates the organization, to reach all
employees and provide guidance on how to act, think, and feel. This explanation suggests
that culture is shared by all employees and is transmitted across generations through
social interaction (Bisin & Thierry, 2005), as it is social in nature (Rai & Panna, 2010).
Culture can be considered as a system (Rai & Panna, 2010) that is created by a group of
individuals in a mutual social environment. Culture is systematic (Keller, 2017) and is
interrelated and interconnected with other factors. This suggests that other elements need
to be considered when studying culture, specifically in the workplace and the
organization.
Most organizations have a dominant culture and multiple subcultures (Khatib, 1996).
Therefore, an understanding of subcultures is important when discussing culture and
organizational culture. There is no commonly agreed description of subculture
(Sackmann, 1991); however, there are a few definitions available in the literature, such as
the one suggested by Khatib (1996), which states that subculture is “a culture that is
separate from the dominant culture and exists in a department, work group, or
geographical location. It includes the core values of the dominant culture plus additional
values unique to its members” (p.6), and the definition by Van Maanen and Barley
(1985), which defines subculture as “a subset of an organization’s members who interact
regularly with one another, identify themselves as a distinct group within the
organization, share a set of problems commonly defined to be the problems of all, and
routinely take action on the basis of collective understandings unique to the group” (p.
38).
38
Subcultures are different from groups in size, where subcultures are larger and often
include a maximum of ten to twelve individuals (Johnson & Johnson, 2005). According
to Cooke and Rousseau (1988), organizational subcultures are formed as a result of
association in multiple groups, depending on unique functions, of the larger organization.
Large organizations mostly consist of one dominant core culture, which includes core
values practiced by most of the employees, and many subcultures which comprise the
dominant culture’s core norms and unique values shared by some members (Khatib,
1996). In a health care context, the organizational culture is shaped by the hospitals and
the hospital wards shape the organizational subcultural (Egan, 2008). Organizational
subcultures usually emerge in response to a mutual issue or situation that is experienced
by multiple individuals of a group in a work environment (Gregory, 1983). However,
subcultures do not necessarily form around subdivisions that already exist, such as groups
in a department or a specific function (Trice & Beyer, 1993). Subcultures may also form
due to varying organizational demands and are considered as venting systems for some
individuals to express distress during times of change and turbulence (Boisnier &
Chatman, 2002).
A trusting subculture plays an important role in increasing organizational commitment
and positive employee attitudes (Spencer-Laschinger, Finegan, & Shamian, 2001).
Studies in health care contexts also confirm that a trusting culture and subculture are
positively linked to increased organizational effectiveness and commitment, in which
subcultures influence employee attitudes (Lok, Westwood, & Crawford, 2005). Results
suggest that subcultures are important for motivation and learning and are even
considered to be more significant than organizational culture in motivating employees to
transfer learning (Egan, 2008).
3.3 Understanding National Culture
It is important to differentiate between national culture and organizational culture
(Hofstede, 1997). National cultures are different in the values that they embrace, while
organizational cultures differ in cultural practices (Hofstede, Neuijen, Ohayv, & Sanders,
1990). National culture refers to the “deeply set values that are common to the members
39
of a nation” (Rafeet, 2010, p. 13) and demonstrates the overall element of a country
(Hauke, 2006). It is comprised of the shared system of values, norms, religion, and
behavior among the members of a nation, while organizational culture is concerned with
the same values that form the organization (Hofstede, 1997). National culture impacts the
culture of the organization; however, this does not necessarily suggest that organizational
culture is determined by national culture, for example in the case of multinational
companies that have affiliates in other countries (Shailashree & Mlembra, 2016).
Hofstede (1997) has presented five dimensions of national culture which help in
understanding the culture of a specific country. Understanding the national culture
dimensions as explained by Hofstede is important, as it impacts business activities and
performance in that country (Dowling, Festing, & Engle, 2008). Hofstede’s national
culture classification system is not only useful in understanding the culture of a country,
but also important in understanding the impact of national culture on people’s behavior
(Matijrvic, Raguux & Filipovic, 2015). Hofstede’s five cultural dimensions are
individualism versus collectivism, uncertainty avoidance, power distance, masculinity
versus femininity, and long-term orientation versus short-term orientation. These
dimensions, explained below, form the basis for discussing the influence of national
culture on organizational culture (Dartey-Baah, 2011):
• Individualism versus Collectivism: Hofstede (1993) referred to this dimension
as “the degree to which people in a country prefer to act as individuals rather than
as members of groups” (p. 89) . In individualistic societies, members look after
their own and their family interests, while in collectivist societies, the interest is in
the cohesive group that is made up of all the individuals in the collectivistic
society (Dartey-Baah, 2011). Individuals from a collectivistic culture expect
loyalty from the group (Dartey-Baah, 2011).
• Power Distance: This dimension refers to the way societies cope with
inequalities amongst members (Aljawi, 2009). In a high-power distance culture,
the less powerful members can accept inequality and power relations (Ogbuigwe,
2013). In addition, individuals in high power distance cultures seek direction and
guidance from their supervisors (Hofstede, 2005).
40
• Uncertainty Avoidance: This dimension refers to a culture’s tolerance and the
extent to which individuals are feel anxious and are threatened by ambiguity and
uncertainty (Hofstede, 1991). On the one hand, a high uncertainty avoidance
culture is more anxious about and does not tolerate uncertain situations and
changes (Dartey-Baah, 2011). On the other hand, a culture with low uncertainty
avoidance is more tolerant and accepts changes (Ogbuigwe, 2013).
• Masculinity versus Femininity: This dimension refers to the difference between
genders in terms of their social role (Dartey-Baah, 2011). Hofstede and Hofstede
(2005) have stated that “a society is called masculine when emotional gender
roles are clearly distinct: men are supposed to be assertive, tough, and focused on
material success, whereas women are supposed to be more modest, tender, and
concerned with quality of life” (p. 120). By contrast, in a low masculine and high
feminine culture, female roles are associated with tenderness and humility, and
caring for non-materialistic needs (Hofstede, 1991; Ogbuigwe, 2013).
• Long-term versus Short-term Orientation: This dimension is defined as the
“orientation in time” of a culture (Hofstede, 2011, p. 4). It refers to the degree to
which individuals within a society have a short- or long-term attitude regarding all
life aspects (Ogbuigwe, 2013). Dartey-Baah (2011) has explained that “long-term
orientation measures the degree to which members embrace planning and
investing for the future” (p. 5). In a long-term orientation culture, traditions are
respected and making changes to situations can be difficult (Dartey-Baah, 2011).
Hofstede’s presented the cultural differences between countries, which resulted in a flow
of practical studies on the impact of culture on the various actions and performance of
multinational organizations (Kirkman. Lowe, & Gibson, 2006). Beugelsdiik and Welzel
(2018) stated that “Hofstede was the first researcher to reduce cross-national cultural
diversity to country scores on a limited number of dimensions” (p.4). Cross-cultural
studies have the most value when it applies to management practices and processes
(Jones, 2007). Hofstede’s framework has been utilized in various business contexts, such
as compensation, training design, conflict resolution, workgroup dynamics and
performance, innovation, and leadership styles (Smith 1998).
41
Hofstede et al. (2010) have further introduced a sixth dimension called Indulgence versus
Restraint, which was originated by Minkov (2011). This dimension refers to the degree to
which individuals are disposed to show emotions and indulge in momentary pleasures
(Beugelsdiik and Welzel, 2018).
There have been numerous studies trying to imitate Hofstede’s framework on cultural
multidimensions. All these studies tried replicating the dimensions without considering
the cultural changes over time. Hofstede’s framework has also been a source of criticism
by various researchers such as McSweeney (2002), Minkov (2018), and Nakata (2009).
Baskerville (2003) and McSweeney (2002) have questioned Hofstede’s data collection
method. Many researchers indicated that employing a survey is not the most appropriate
data collection method to accurately determine and measure the difference in culture
(Jones, 2007), which is apparent when the measured variable is subjective and culturally
sensitive (Schwartz 1999). Brewer and Venaik (2014) state that there is an environmental
fallacy in the research design, which suggested that scores are invalid. Javidan, House,
Dorfman, Hanges, and de Luque (2006) have questioned the representative sample and
explained that it might be specific to the US and IBM. Hofstede’s considered the
domestic population as homogenous, while most nations are sets of ethnic units (Redpath
1997). Another area of critique is the dimensions (such as Individualism vs. Collectivism)
and content validity (Minkov, 2018). Hofstede differentiates between Individualism and
Power Distance for they are considered as theoretically dissimilar (Hofstede, 1980).
According to Smith, Dungan, and Trompenaars (1996), Power Distance versus Closeness
and Individualism versus Collectivism are one factor, in which Power Distance and
Individualism integrate into one pole. Conceptually, they signify the two ends of the
same dimension. Additionally, there were some political issues at that data collection
stage that may have affected the outcomes of other dimensions such as Masculinity
(Søndergaard 1994) and Uncertainty Avoidance (Newman, 1996). Venaik and Brewer
(2013) analyzed the LTO dimension and identified the inconsistencies in the definitions
and measurement. Fang (2003) had also discovered numerous issues in the concept and
methodology in the LTO dimension.
42
The national culture strongly influences organizations and is considered to impact 50% of
the changes in values, religion and attitudes in an organization (Treven, 2011). Although
organizational culture is placed within the national culture of a country, national and
organizational cultures are distinct and different concepts (Pothukuchi, Damanpour, Choi,
Chen & Park, 2002). Organizational culture and national culture are two important
constructs in the business literature. In the context of business, Hofstede (1997) has also
explained that it is important to distinguish between national and organizational culture.
Hofstede, Geert, Neuijen, Ohayv and Sanders (1990) have explained that national culture
varies at the value level, whilst organizational culture varies at the level of practices and
symbols. Therefore, the same organization in different nations, such as a multinational
company, needs to consider the national culture of the country where it operates, as this
impacts the strategies, policies, and structure of the organization (Dartey-Baah, 2015).
3. 4 The Concept of Organizational Culture
Researchers have provided various definitions for organizational culture. Schein (1985)
has defined organizational culture as “a pattern of shared basic assumptions that the
group learned as it solved its problems of external adaptation and internal integration that
has worked well enough to be considered valid and, therefore, to be taught to new
members as the correct way to perceive, think, and feel in relation to those problems” (p.
12). This definition suggests that organizational culture consists of cultural elements that
include the values, beliefs, behaviors, and assumptions or norms that members of an
organization share and have in common (Armstrong, 2001). Organizational culture can
also be defined as a shared set of meanings, understanding, and other cultural elements
demonstrated by a group of individuals (Tsai, 2011) within an organization. Hofstede
(1980) has described culture as being holistic, historically made, socially created, and
difficult to alter. He has stated that organizational culture is “the collective programming
of the mind which distinguishes the members of one organization from another” (p. 25).
As indicated in the previous section, organizational culture is a level of culture (Hofstede,
2010), in which organizational culture encompasses all the characteristics of culture, such
43
as the social element. This suggests that organizational culture can be transmitted to other
members of the organization through social interaction (Tsai, 2011).
There are multiple organizational culture frameworks, dimensions, and models available
in the management literature, such as the models developed by Schein, Hofstede, and
Denison. Denison (1990) has conceptualized organizational culture in relation to its
effectiveness in terms of four traits: involvement (the employees’ participation in
decisions that impact them), consistency (the presence of processes that promote
efficiency over time), adaptability (internal change as a response to an external condition)
(Denison & Mishra, 1995), and mission (the purpose why the organization exists).
According to Denison (1990), these four traits measure “the underlying values, beliefs,
and principles that serve as a foundation for an organization’s management system as
well as the set of management practices and behaviors that both exemplify and reinforce
those basic principles” (p. 2). Organizational culture exists at various levels and Schein
(1988) has suggested three organizational culture levels, namely artifacts, values, and
underlying assumptions. Schein (1988) has provided an explanation of each level:
artefacts are concerned with individual senses when entering a culture; values are the
goals, moral principles, and norms; and the underlying assumptions are unconscious
basic assumptions and lie beneath the values.
Each organization has its unique culture, which is reflected in two dimensions, visible
and invisible, which can be demonstrated at various levels within the organization
(Delong & Fahey, 2000). The visible dimension is observed in “the espoused values,
philosophy, and mission,” whilst the invisible dimension is reflected in the “unspoken set
of core values” and basic assumptions that direct the employee’s actions and perceptions
(McDermott & O’Dell, 2001, p. 77). The most visible dimension of Schein’s three
organizational culture levels is artifacts, while values represent the least visible
dimension (McDermott & O’Dell, 2001).
The culture of an organization impacts the employees’ actions, perceptions (Denison,
1984), and work (O’Donnel & Boyle, 2008). A strong organizational culture is present
when all employees in an organization adopt or follow the same behavioral pattern that
44
benefits the organization (Odor, 2018). According to Kotter and Heskett (1992), cultures
where the goals of the employees are aligned to goals of the organization are frequently
considered as successful cultures. A strong organizational culture is synonymous with a
healthy work environment, which can enhance the performance of individuals (Ahmed,
2012) and can result in efficient and productive employees (Li, 2015). Such strong
cultures can be considered a component for sustaining competitive advantage and
performance, which is essential in this era of globalization and international competition
(Madu, 2011). As such, managers can leverage a strong organizational culture to achieve
organizational success.
There are multiple organizational factors that affect knowledge transfer processes and
impact their effectiveness, such as information technology, organizational culture,
structure, and processes (Islam, Hasan & Rahman, 2015). Amongst these aspects, cultural
factors are the most challenging (Koudsi, 2000). Organizational culture was identified as
the most critical factor that affects the knowledge transfer process (Hauke, 2006) and has
a mixed impact on knowledge transfer (Aljawi, 2009). Cultural similarities and distances
in an organization affect the transfer of knowledge: the greater the similarities, the higher
the probability of knowledge transfer to occur, and the greater the differences between
cultures, the lower the probability of knowledge transfer to take place (Perrin & Rolland,
2007).
Organizational culture refers to notions and perceptions that employees share regarding
an organization (Malat, 2001). Organizational culture positively affects business
performance in health care (Acar & Acar, 2012), which can lead to organizational
success. Understanding the organizational culture in health care organizations is crucial,
as it impacts the overall organization’s management system, which indirectly affects
patient care (Najafi, Hamidi, Ghiasi & Emami, 2011).
Research on organizational culture has recently extended to the investigation of the
impact of culture on organizational outcomes such as performance, effectiveness,
success, effectiveness, and knowledge management in general. Despite multiple studies
having been conducted on organizational culture, not many research studies have
45
explored the link between organizational culture and knowledge transfer. This makes the
present research study, which explores the impact of organizational cultural on
knowledge transfer, particularly valuable.
3.5 Organizational Culture and Knowledge Transfer
The culture of an organization is shaped and influenced by the national culture of the
country in which it is situated (Lindholm, 2000). Multiple researchers have suggested that
national culture has a strong influence on several organizational activities (Ansah &
Louw, 2019). Hofstede (2001), amongst others, has explained that national culture
impacts the activities of organizational culture, where national cultural values, beliefs,
and norms are enforced on organizations (Hofstede, Hofstede, & Minkov, 2010).
However, Pothukuchi et al. (2002) have suggested that Hofstede’s national culture
dimensions have various effects on organizational outcomes, where some are more
disruptive and more associated with issues than others, such as individualism versus
collectivism and power distance (Hofstede, 1983). Despite the cultural challenges, the
major approach to overcome such challenges is to build a strong organizational culture
that would “overpower” and “erase the differences” of national culture (Makovetska,
Anjoom & Abbasi, 2017, p. 1). Some national culture dimensions impact on
organizational activities more than others. Bhagat et al. (2002), for example, have
proposed that individualism versus collectivism impacts on knowledge management, as it
is associated with relationships (Hofstede, 1991). Knowledge transfer is an important
aspect of knowledge management (Shahmoradi et al., 2017); therefore, individualism
versus collectivism affects knowledge transfer as well, as knowledge transfer is
influenced by relationships. An organizational culture that has a high level of
collectivism supports sharing information, which leads to a higher level of knowledge
transfer (Makovetska et al., 2017).
Al-Alawi, Al-Marzooqi and Mohammed (2007) have proposed that leadership style,
people, and the reward system shape the culture of an organization. Hofstede (1983) has
explained that individualism versus collectivism and power distance affect leadership
style. This suggests that the process of knowledge transfer would be more effective if it
46
was supported by the leaders of an organization. In addition, a more collectivistic
organization with low power distance level would support the transfer of knowledge
within an organization where employees would be motivated to transfer knowledge.
The existing literature has outlined several cultural factors that impact knowledge transfer
(Chen, Sun & McQueen, 2010). The cultural context has been identified as a cultural
factor that impacts the knowledge transfer process, where knowledge is likely to be
transferred more effectively if the knowledge holder and the receiver are of the same
cultural context (Bhagat et al., 2002). Communication is also recognized as another
cultural factor that affects knowledge transfer (Chen et al., 2010). Language is an
important aspect in communication, where the knowledge holder and the receiver need to
speak the same language to transfer knowledge. The absence of a shared language can
hinder the knowledge transfer process (Grant, 1996). Speaking a common language is
crucial in any organization and it is an important factor for successfully transferring
knowledge (Davenport & Prusak, 2000).
3.6 An Overview of Saudi Arabia
The increase in global interactions and the rise in modern technology have led to a drastic
growth in international business and global competition. This has directed the attention
and focus of organizational culture researchers to understand and study cultural
differences in an international and global context. The need to examine cultural
diversities across nations and to investigate their influence on various organizational
activities continues to increase, especially in countries with unique cultural and social
characteristics such as Saudi Arabia.
Saudi Arabia has gone through an array of drastic and substantial changes in recent years.
It has witnessed and probably will continue to see significant economic and social
transformation and changes. These changes require an understanding of cultural reform
and how it affects organizational culture, which in turn impacts knowledge transfer as a
business strategy to remain competitive in international markets.
47
A limited number of studies have been conducted in Saudi Arabia. This suggests that
researchers have refrained from conducting research in the Arab world in general and in
Saudi Arabia in particular, as it might be challenging and difficult. This might be
attributed to the perception that securing approval for research, accessing information,
and data retrieval are problematic, perhaps due to strict government rule and regulations.
3.6.1 Culture of Saudi Arabia
The culture of Saudi Arabia can be described as a unique and conservative culture that is
defined by Islamic principles. Saudi Arabia is perceived as having a homogeneous
Islamic society in which all social, economic, political, and legal matters are directed by
Islamic principles (Algumzi, 2017). The Saudi society is generally conservative and
members within this society share common cultural values. However, it is worth
mentioning that the society in Saudi Arabia is not entirely homogenous, as it is
diversified in a unique way, in which some Saudi societies are impacted by their origin,
tribal traditions and norms that form their own tribal identity (Aldhobaib, 2017). This
unique aspect of Saudi culture describes the collectivistic attributes, as explained by
Hofstede (1991).
The culture of a country impacts every aspect of the life of the individual. The Saudi
culture is different from other cultures, as it is influenced by several factors: the religion
of Islam, Saudi history, and specific traditions (Alkahtani, Dawson & Lock, 2013). Saudi
culture is a blend of Islamic and traditional Arabic customs and beliefs (Abu Nadi, 2012).
Understanding the Saudi cultural differences can have a strong impact on the success of
organizations in Saudi Arabia (Alkahtani, et al., 2013). Organizations in Saudi Arabia are
expected to be impacted by the same cultural elements of its society. This suggests that
the Saudi culture and its strict religious values shape the culture of the organizations
which operate in this nation.
Several researchers have explored Hofstede’s cultural dimensions for the purpose of
understanding the underlying principles of culture and communication in Saudi Arabia
(Al-Gahtani, Hubona & Wang, 2007). Hofstede (1983) has characterized the Arab
48
countries, including Saudi Arabia, as being a collectivist culture, with a high-power
distance level, high uncertainty avoidance, and a masculine society. Saudi Arabia scores
low on long-term orientation, as it focuses on short-term results and has respect for
societies (Ourfali, 2015).
Saudi Arabia has a high-power distance, meaning the structure of organizations in Saudi
Arabia are hierarchical and formal. Saudi Arabia is considered a highly collectivistic
society, in which loyalty to the group is crucial and the interests of the group are far more
important than the interests of the individual. Individuals depend on groups and authority
figures (Hofstede, 1994). In an organizational context, these two cultural dimensions
might result in centralization and management issues, in which the employee’s loyalty is
to the manager and not necessarily to the organization (Obedidat, Shannak, Masa’deh &
Al-Jarrah, 2012). However, Hauke (2006) explained that individuals in a collectivist
culture are more eager and motivated to share and transfer knowledge than individuals in
an individualist culture. AlJawi (2009) confirmed that knowledge sharing occurs more in
a collectivist society as opposed to an individualist society; yet, the knowledge remains
within the society group.
Saudi Arabia scores high on the masculinity index; this denotes that the Saudi culture
values achievements and success (Hofstede, 2001). Saudi culture has a high uncertainty
avoidance, which is evidenced by its strict adherence to traditions, cultural, tribal, and
religious beliefs, and values. Saudi Arabia is a short-term-oriented society that values
traditions and stability and has a low preference for saving, which, as explained by
Hofstede (2001), is attributed to Islamic religious traditions.
Dwyer, Mesak and Hsu (2005) have suggested in their study that cultures characterized
as collectivist, masculine, with high power distance and short-term orientation have a
positive association with the implementation of technological innovations. This might
explain the recent transformation and enhancement of the health care sector in Saudi
Arabia and the influx of new technical equipment in the Saudi health care system, as the
Saudi culture accommodates and accepts such advancements and innovations.
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3.6.2 Health Care in Saudi Arabia
Currently, Saudi Arabia is going through a transformational stage as a result of adopting
the new strategic plans, the Saudi Vision 2030 and the National Transformation Program
(NTP) 2020 (Al-Hanawi, Khan, & Al-Borie, 2019). The Saudi Vision 2030 (2016) and
the NTP were adopted in 2016 and are considered a blueprint for the economic
development of Saudi Arabia (Al-Hanawi et al., 2019). These plans identify the policies,
general directions, and objectives of Saudi Arabia. Ministries, institutes and all
government entities have all gone through restructuring and reorganization to align their
strategic initiatives and key performance indicators (KPIs) with the new Saudi Vision
2030 (2016). Implementing this vision comes with a set of challenges and opportunities
for all sectors in Saudi Arabia, including the health sector.
The Saudi health care system was ranked 26th by the World Health Organization (WHO),
higher than other Arabian countries and ahead of other health care systems in developed
countries (WHO, 2000). Despite these accomplishments, the pressure is on health care
facilities to provide better health care services to the growing population of Saudi Arabia
(Al-Hanawi et al., 2019). The Saudi government has expressed its commitment to
developing and improving the health care offered to the Saudi population (Almalki,
FitzGerald & Clark, 2011). It is demanded of health care facilities to have a workforce of
trained health care professionals. There is also a much greater demand for more research
on health care in Saudi Arabia. Not many studies have been conducted and published that
focus on health care in Saudi Arabia. Researchers need to be encouraged to conduct more
studies in Saudi Arabia, utilizing available resources and exploring the various areas of
the health care sector.
3.7 Conclusion
The previous chapter presented a literature review that focused solely on exploring all the
underlying principles related to the concept of knowledge and knowledge transfer. It also
outlined the factors that affect the transfer of knowledge in organizations and a brief
discussion on knowledge transfer in health care organizations.
50
This chapter also presented a review of the theoretical literature and provided a further
conceptual framework to address the research questions of this study. The chapter
focused on examining the literature in the area of organizational culture. It also offered an
overview of the culture of Saudi Arabia and its health care system. The chapter began
with a literature review that discussed the concepts of national and organizational culture,
emphasizing the importance of understanding organizational culture and its implications
for knowledge transfer.
Recent studies have explained the concept of organizational culture. However, not many
studies have focused on understanding how organizational culture impacts the significant
organizational activity of knowledge transfer in a health care setting in a culture-sensitive
country such as Saudi Arabia. This study seeks to fill this knowledge gap and contribute
to the understanding of the organizational cultures in Saudi Arabia and how they impact
on the operation of organizations in the critical sector of health care. The review of the
literature offered in this chapter was intended to develop the conceptual framework which
serves as a foundation for the next chapter. The next chapter presents the methodological
approach of this research study.
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Chapter 4: Research Methodology
In the Eyes of the Knowledge Holder: Exploring the Impact of Organizational
Culture on Knowledge Transfer
4.1 Introduction
The main themes related to this research were discussed in the previous chapter. This study
employs a case study as the research methodology. Chapter 2 built on the existing research,
which forms the analytical framework for this study. Guided by the research questions, this
chapter focuses on the research methodology. The chapter starts with a discussion of
debates on research philosophy. It then introduces the research methods selected to answer
the research questions and explains the reasons behind this selection. The chapter also
describes the target groups, the data collection tools utilized, and the data analysis
approaches. Then the research limitations are outlined, followed by a reflection on the
research results. It concludes with the ethical issues faced during the research process and
a few closing thoughts pertaining to the overall research process.
4.2 Research Scope
The research process of this study involves five stages: 1. identifying the aim of the
research, 2. selecting a suitable methodological approach, 3. defining the conceptual
framework, 4. designing a research strategy, and 5. collecting and analyzing the data. The
research aim is to understand the impact of organizational culture on the knowledge
transfer process in the health care sector, to address the knowledge gap in this field and
address the research questions introduced in previous chapters.
The methodological approaches adopted for this research study were both quantitative
and qualitative and two methods of data collection were used, namely self-administered
online questionnaires and semi-structured interviews. Utilizing both quantitative and
qualitative methods in a research study is referred to as mixed methods research
(Creswell, 2003). Applying both quantitative and qualitative methods strengthens the
overall research, since the quantitative method provides rigidness and standardization
52
(Patton, 1990), while the qualitative method offers an in-depth analysis of the studied
phenomenon.
The research strategy that steered this research exploited the strengths of both
quantitative and qualitative approaches. The study consisted of two phases: the first phase
features a deductive method applying quantitative research and the second phase involves
an inductive stance applying qualitative research. The research employed both
quantitative and qualitative data collection approaches, namely self-administered online
surveys and semi-structured interviews. The collected data from both approaches were
then analyzed separately and the results interpreted.
4.3 Research Philosophy
Research philosophy is mainly concerned with the construction of knowledge and its
nature (Saunders, Lewis & Thornhill, 2007). It primarily reflects the research study’s
views and gives an overview of the research direction. It is important to understand the
research philosophy prior to presenting the research design and methods used. Mkansi
and Acheampong (2012) have categorized research philosophies into ontological and
epistemological paradigms and have expounded on how these apply to the qualitative-
quantitative debates. The quantitative and qualitative debate refers to the different
epistemological positions of both research methods, which is mainly related to
knowledge and its formation (Sale, Lynne & Brazil, 2002). There are two main
epistemological paradigms that result in philosophical and methodological differences
(Sale et al., 2002): positivism (quantitative) and phenomenology (qualitative).
The literature review identified a number of theoretical and philosophical positions
pertaining to organizational culture and how it impacts on the transfer of knowledge
within the context of organizations. The research study’s main objective is to bridge the
gap in the literature by identifying the organizational culture factors that affect the
knowledge transfer process in health care. A mixed methods approach, which involves
utilizing quantitative and qualitative approaches, is applied to achieve the research
objective. Utilizing the strengths of both research approaches is imperative to increase the
validity of the results (Goodwin & Goodwin, 1984) and the overall meaningfulness of the
53
research. The study attempts to understand the impact of organizational culture on the
process of knowledge transfer, which was achieved by exploring the perceptions of both
managers and employees towards the concepts of organizational culture and knowledge
transfer, by employing a quantitative positivist approach and a qualitative interpretivist
approach.
Quantitative research is grounded in the positivist paradigm (Sale et al., 2002). Positivism
is based on the natural sciences and seeks facts as opposed to values, which can be
characterized as objective and not subject to bias (CLMS, 2004). Positivism is based on
the assumption that reality can be predicted (Wing, 2003). In terms of this paradigm, the
researcher envisions a phenomenon as encompassing a set of variables that form the
reality, which can be investigated independently without the influence of external
surroundings (Sale et al., 2002). This phenomenon can be measured to generate findings
using numerical data, which are analyzed using statistical tools (Bielefield, 2006). In
summary, quantitative research involves rigid and structured methods which are applied
to a large population to extract numerical data, which are interpreted using a rational and
bias-free approach to obtain objective knowledge (Potter, 2000). However, the adequacy
of this paradigm for studying social phenomena has been a cause for debate among social
scientists (Bielefield, 2006).
Qualitative research is grounded in the interpretivist paradigm (Kuzel & Like, 1991).
Interpretivism relies on the belief “that reality consists of people’s subjective experiences
of the external world; thus, they may adopt an inter-subjective epistemology and the
ontological belief that reality is socially constructed” (Thomas, 2010, p. 5). This suggests
that interpretivists believe that reality relies on others and the world for meaning
(Greener, 2008), so that one of their main sources of meaning is to understand
interactions between subjects and individuals. This can be achieved by interpreting
individual perceptions and opinions (Neuman, 2000). However, one of the main issues
with this approach is subjectivity to bias. Phenomenology can be considered as the
philosophical foundation of qualitative research (Padilla-Diaz, 2015). Phenomenology
aims to understand and describe a phenomenon from the perceptions of the surrounding
environment (Welman & Kruger, 1999), in which the phenomenon is closely examined
54
(Groeneward, 2004). Phenomenology seeks meaning through understanding and
interpretation, as it recognizes all knowledge as “value-laden” (CLMS, 2004, p. 13).
Phenomenologists’ main intention is interpretation and meaning and qualitative research
methods serve this purpose; these methods mainly include focus groups and in-depth
interviews (CLMS, 2004). The primary goal of qualitative research is to understand and
describe a phenomenon, based on individuals’ experiences using qualitative data
collection approaches such as in-depth interviews. A constructivist perspective is directed
at gaining a deep and comprehensive understanding of a social phenomenon to provide
meaning (Addae & Quan-Baffor, 2015).
4.4 Research Approach
The research approach was chosen based on the exploratory nature of the research, which
aims to identify the organizational culture factors that impact on the knowledge transfer
process in a health care organization. An amalgamation of both quantitative and
qualitative research methods was utilized for this research. The research study
investigates the interaction in an organization of individuals with various backgrounds,
behaviors, perspectives on the culture of the organization and knowledge transfer
practices. The research involves the investigation of an actual situation in a health care
organization, which requires a deductive approach. However, to gain an in-depth view of
the organization and how both concepts of organizational culture and knowledge transfer
are perceived, an inductive approach must be employed. Accordingly, an abductive
approach has been employed, in which both deductive and inductive approaches were
implemented to achieve the research objectives presented in Chapter 1.
The identification of factors through self-administered online questionnaires was
followed by in-depth, one-on-one, semi-structured interviews. The questionnaires were
able to determine how managers (strategic roles) perceive the culture of the organization
and to identify the underlying factors that influence knowledge transfer. Through one-on-
one interviews the research was able to cross-check these results with employees’
insights (functional roles) concerning the same concepts in the same organization.
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This research study adopted a mixed approach, utilizing the strengths of both qualitative
and quantitative data collection methods, allowing for more robust and structured data
and results. In mixed methods research, the strengths of the additional approach are used
to overcome the limitations of the other approach (Johnson & Onwuegbuzie, 2004).
Johnson and Onwuegbuzie (2004) have added that including an additional method
provides “stronger evidence for a conclusion through convergence and corroboration of
findings” (p. 21) and “insights and understanding that might be missed when only a
single method is used” (p. 21). In this study, a two-phase sequential design was
implemented, where phase one was designed based on a review of the literature and the
results of phase one were utilized to design and confirm the purpose of phase two.
Phase one of the study employed self-administered online questionnaires as the
quantitative data collection approach. This initial phase was followed by phase two,
which employed face-to-face, semi-structured interviews as the qualitative data collection
approach. The self-administered online questionnaires, despite their failure to offer direct
contact or interaction between the researcher and the respondent, allowed the researcher
to obtain an acceptable number of responses within a set time frame (Bryman, 2004). The
face-to-face interviews, despite being time-consuming, gave the researcher the
opportunity to interact directly with the participants and ask more questions for further
clarification.
In mixed method studies, questionnaires commonly used with other qualitative methods
(Akinci & Saunders, 2015). Online questionnaires and semi-structured interviews were
utilized as data collection methods in this research, in which both approaches provide
different aspects in terms the findings and allows to explore different dimensions of the
research. According to Dilman (2009), three forms of data variables can be extracted
from questionnaires, which include opinions, behavior, and attributes, the opinion entails
the respondents’ feelings towards the research topic, the behavior captures the
respondents’ experience, and the attribute includes the respondents’ characteristics such
as education and age.
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Therefore, a self-administered online survey was employed to obtain a generic overview
of the concepts of organizational culture and knowledge transfer practices in the health
care organization as perceived by the managers and identify the organizational culture
factors that impact the transfer of knowledge. Semi-structure interviews followed to get a
deeper dive into the organization’s culture and explore the relationship between
organizational culture and knowledge transfer practices as perceived by various groups of
clinical and non-clinical employees within the health care setting. Additionally,
interviewing the employees assist in validating the results obtained by the managers
regarding the organizational culture and knowledge transfer practices.
In semi-structured interviews, researchers can comprehensively explore all aspects of the
research questions and ensure that all the questions are interpreted correctly by the
interviewees (Denscombe, 2014). Semi-structured interviews also give the researchers
the flexibility to investigate a particular issue or emerging themes. One of the objectives
of incorporating semi-structured interviews in this research was to gather specific data or
information related to the participants’ understanding of their organizational culture, the
knowledge transfer activities practiced in the organization, and if a relationship exists
between the organizational culture and the knowledge transfer activities. Face-to-face
interviews allow the researcher to obtain in-depth data and gain a better understanding of
the concepts under investigation and give the interviewees an opportunity to share their
experience and opinion (Silverman, 2013).
Research methodology usually includes two main stages: planning or research design and
execution or implementation (Younus, 2014). For this research study, two phases were
employed. The following sections provide a description of both stages of the research.
4.4.1 Quantitative Approach
The first phase involved a quantitative approach, in which a preliminary understanding of
the perceptions of managers towards organizational culture and knowledge transfer
processes was established. Malhotra and Birks (2007) have defined quantitative research
as “a research methodology that seeks to quantify data and, typically, applies some form
of statistical analysis” (p. 152). Quantitative research methods include descriptive,
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correlational, quasi-experimental and experimental approaches (Cormack, 1991). The
strength of this methodology is that both “true experiments and quasi-experiments
provide sufficient information about the relationship between the variables under
investigation to enable prediction and control over future outcomes” (Carr, 1994, p. 7).
Carr (1994) has added that survey questionnaires seem to be the preferred tool of this
research, because they can be designed to fit the desired purposes of the research. One of
the disadvantages of quantitative research methodology is the complete omission of the
individual’s experiences, where individuals are considered as objects that simply react
and respond to their environment (Cormack 1991).
In quantitative research, data collection is in the form of numbers (Saunders, Lewis &
Thornhill, 2016). Using a quantitative approach enables the researcher to collect a large
amount of data that can be compared using reliable numerical tools. Creswell (2009) has
explained that the quantitative method allows for the examination of a hypothesis or
theory by applying a deductive approach (Borrego, Douglas, & Amelink, 2009) and the
data collection would follow the theory (Pathirage, Amaratunga, & Haigh, 2008).
Quantitative data were collected via self-administered online questionnaires distributed
amongst managers from three different levels in the organization. The use of this
approach provides the research with the reliability and validity of statistical analysis,
which results in logical data interpretation (Creswell, 2009). The quantitative method was
implemented in this research to extract demographic data, including educational
background, years of experience, and other variables. The questionnaire was also used to
identify the organizational culture factors that impact on knowledge transfer. The
identified factors were used to develop the semi-structured interviews that followed the
questionnaire. The questionnaire was chosen as a method of data collection due to its
feasibility, eases of use, short time frame, and cost effectiveness. Borrego et al. (2009)
have explained that “quantitative methods are one technique that can be employed when
examining a particular issue but other research designs, such as qualitative methods, may
offer additional insights” (p. 55). The next section discusses the qualitative approach
employed in this research study.
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4.4.2 Qualitative Approach
The second phase involved a qualitative approach, which utilized semi-structured
interviews. Malhotra and Birks (2007) have defined qualitative research as “unstructured
primarily exploratory design based on small samples intended to provide insight and
understanding” (p. 152). Qualitative inquiry can be considered research that examines
collected data in real-world settings, by creating an understanding of a specific
phenomenon by using approaches that capture individuals’ feelings, beliefs, and points of
view (Berkwits & Inui, 1998). In qualitative research, data collection is in the form of
“textual data” (Borrego et al., 2009, p. 55) and individual perspectives and opinions
(Saunders et al., 2016). When using a qualitative approach, the researcher collects
individual perceptions which assist in understanding the investigated phenomenon
(Creswell, 2009). An inductive approach is utilized in qualitative research, where the
theory is developed based on the data collected (Pathirage et al., 2008).
Based on the results of the questionnaire, it was important to conduct a deeper
investigation to understand the issues related to knowledge transfer and some of the
concepts related to the organizational culture identified. In this research, some of the
semi-structured interview questions were designed based on the themes and results
extracted from the survey questions. The quantitative survey results suggest that
organizational management and communication are amongst the main factors that impact
the transfer of knowledge in the organization. Additionally, according to the
questionnaire, meeting the needs of customers and patients is revealed to be the factor
that has the most significant impact on the organizational culture. These findings were
shared with the respondents during the interview stage, and they were asked if they agree
or disagree with these results and to give the reason behind their answers. These
outcomes or results needed clarification. Is there a relationship between meeting the
needs of customers or patients and knowledge transfer? Is this a shared value exhibited
by all employees in this health care organization? This has also led to the decision to add
the ‘state your position and job title’ question in the interview stage, which can help
distinguish between the clinical staff and non-clinical staff and understand if both groups
share the same view of organizational culture, values, and knowledge transfer practices in
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the organization. Additionally, the respondents were asked to list some of the knowledge
transfer activities practiced in the organization and how the organization communicates
the mission, vision, and initiatives to employees. The answers to these questions by the
employees during the interviews help validate the answers provided in the questionnaire
by the managers.
Qualitative data was collected during 10 one-on-one interviews. The first phase involved
a quantitative approach, in which a preliminary understanding of the perceptions of
managers towards organizational culture and knowledge transfer approaches were
established. Following an analysis of the results collected from the managers, the second
phase of the study involved obtaining feedback from employees regarding the
organizational culture factors that impact on knowledge transfer. In addition, employees’
perspectives on the knowledge transfer practices implemented in the organization were
obtained. Quantitative research approaches restrict the researcher’s ability to investigate
in-depth the perspectives of an individual on a specific subject (Thomas, 2010). The use
of qualitative research allows the researcher to thoroughly and deeply explore themes and
relationships (Domegan & Fleming, 2003), to obtain meaning and investigate individuals
in their natural environment (Amaratunga et al., 2002). In qualitative research, data are
collected in a natural setting, capturing a real-life context, which offers the elements of
openness and reality to the research study (Amaratunga et al., 2002).
4.5 Research Setting
For this research the setting had to be a health care organization, in a convenient location
for me in Saudi Arabia, which applies to the health care organization for which I work.
Gaining access for the research was not expected to be an issue, as I already work at this
organization. Full access was obtained to this organization, whose name will remain
anonymous, as requested by the organization’s management.
The research was undertaken in a health care organization in Saudi Arabia. This
organization is the result of a joint venture between two world-renowned companies,
whose names will remain anonymous for confidentiality reasons. With around 480 beds
and almost 4,000 employees, this hospital serves around 350,000 patients. This health
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care organization has four clinics, in five different locations (Dhahran, Abqaiq, Ras
Tanura, Udailiyah, and Hasa), all situated in Saudi Arabia. The main hospital building is
in Dhahran, where all the inpatient and specialty services such as radiology, dermatology,
obstetrics/gynecology etc. are offered. The other districts have small outpatient clinics
and emergency services but do not offer specialty services to patients. These clinics have
laboratories for basic testing, pharmacies, and emergency services. Critical and difficult
health cases are handled at the main hospital in Dhahran. The employees at this health
care organization are multinational.
This research is unique as it was conducted in Saudi Arabia, in the health care context. As
explained in Chapter 3, few researchers consider Saudi Arabia as a research setting. This
might be attributed to its unique strict social culture or to the perception that it is difficult
to obtain access for research to organizations situated in Saudi Arabia. Cultural and
organizational studies have mostly been conducted in Western countries, where access
for research purposes is perhaps easier. Researchers have encouraged exploring different
contexts, which result in diverse findings (Johns, 2006) and unique contributions to the
research literature. The findings of this research make empirical contributions to
organizational management research in general and Saudi Arabian research in particular.
4.6 Research Design and Phases
The research design implemented in this study is an instrumental case study of a single
health care organization. The instrumental case study uses a specific case to gain insight
on a particular issue (Crowe, Cresswell, Robertson, Huby, Avery, & Sheikh, 2011). The
health care organization was a suitable context and specifically selected as the case study
for this research, as it was convenient and suitable as the researcher was an employee in
this organization.
In case study research, the “researcher explores in depth a program, an event, an activity,
a process, or one or more individuals” (Creswell, 2003, p. 15). Case studies offer an in-
depth investigation of an actual case within its context (Ridder, 2017); this case can be an
individual, an issue, or an organization (Yin, 2014). A case study was employed in this
research as it “seeks to understand the dynamics present within a particular setting”
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(Eisenhardt, 1989, p. 534) and focuses on studying “a contemporary phenomenon within
its real-life context” (Yin, 1994, p. 13). Case studies assist in understanding and
explaining a specific phenomenon, situation, or event (Yin, 2009). One of the advantages
of a single case study is that it provides a comprehensive description to help gain a better
understanding of a phenomenon (Riddler, 2017) and provides an opportunity to explore
the deeper origins of this phenomenon (Fiss, 2009). According to Crowe et al. (2011),
“case studies may be approached in different ways depending on the epistemological
standpoint of the researcher” (p. 4). For this research, both positivist and interpretivist
approaches were employed.
The research design sets the framework and the building blocks that the data collection
approach will rely on. It can be considered as the research blueprint that reveals the
study’s overall outline. It also directs the research on how to answer the research
questions and achieve the research objectives. The research design includes four aspects:
the research setting, the sample group selection, the data collection approach, and the
pilot survey.
Creswell, Clark, Gutmann and Hanson (2003) have explained that “mixed methods study
involves the collection or analysis of both quantitative and/or qualitative data in a single
study in which the data are collected concurrently or sequentially, are given a priority,
and involve the integration of the data at one or more stages in the process of research”
(p. 212). The use of a mixed approach in this research assisted with investigating
additional factors that impact or inhibit the transfer of knowledge in an organization. The
mixed methods research included two types of data gathering approaches, an online self-
administered questionnaire (quantitative method) and semi-structured interviews
(qualitative method). The questionnaire collected data related to demography and
organizational culture factors that impact on knowledge transfer. The semi-structured
interviews presented the opportunity to investigate and explore the information extracted
from the questionnaire. Combining both quantitative and qualitative methods by using
questionnaires and semi-structured interviews strengthens the findings and results
obtained and are expected to provide additional factors that impact on the transfer of
knowledge. The obtained findings and extracted results add to the overall understanding
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of organizational culture traits and the various factors related to the transfer of
knowledge.
Mixed methods studies are challenging to employ as they require careful planning,
including the sequence of the quantitative and qualitative research (Wisdom & Cresswell,
2013). As explained earlier, the research design included two phases: phase one
employed the quantitative research approach and phase two employed the qualitative
research approach. The design of this research was initiated in phase one by distributing
self-administered online questionnaires amongst the organization’s managers. This was
followed by phase two, which comprised of semi-structured, one-on-one interviews with
employees from two different departments, one group occupying clinical jobs and the
other non-clinical jobs. Knowledge transfer and organizational culture were the main
concepts that were highlighted throughout the data collection. As mentioned, the data
collection process was carried out in two phases. The rationale behind this was to enable
a comparison between the collected data and to find correlations, if any. The quantitative
method of the research was geared to collecting and identifying data and the qualitative
method sought to validate and understand the collected quantitative data (Amaratunga,
Baldry, Sarshar, & Newton, 2002).
4.6.1 Phase One: Quantitative Research Approach
4.6.1.1 Sample Selection
The research sample for this phase included three management levels in the organization,
namely top or senior level, middle level, and low or frontline level. This organization has
four management levels, which differ based on the level of importance, responsibilities,
(Rezvani, 2017) and span of control:
• Corporate suite (C-suite) such as the Chief Executive Officer (CEO), Chief
Nursing Officer (CNO), Chief of Staff (COS), etc. C-suite members make
decisions that affect the overall organization and are responsible for setting
organizational goals.
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• Top or senior management reports directly to the C-suite, such as directors and
department heads.
• Middle-level management comprises managers who report to senior management,
such as general managers and division heads. This level of management is
responsible for cascading the organizational goals to the frontline management
and interacting with frontline managers.
• Low-level or frontline management comprises first-level managers, such as shift
supervisors and unit managers. Organizations usually have more lower-level
managers. Frontline managers are responsible for managing daily tasks and
interacting directly with top-level managers and employees.
The managers, excluding the C-suite, were selected as the research sample as they were
expected to possess significant and critical organizational knowledge pertaining to the
organization. The managers’ opinions were also expected to represent the core values of
the organization. In addition, this research intended to utilize the managers’ interactions
with their employees to understand the organizational culture and knowledge transfer.
It is worth mentioning that I was working at the health care organization where the
research was conducted. A good relationship had already been established with most of
the respondents, including the managers at all levels of the organization. Feelings of
solidarity worked to my advantage in this situation, as this resulted in easy access to all
the resources necessary for this research and getting the managers’ buy-in to conduct the
research. Building rapport with the respondents and gaining their commitment were
important, as each respondent was expected to spend some time completing the survey
and sharing their opinions by writing comments.
It was originally anticipated at the start of this research that access would easily by
granted to me as an inside researcher and that data collection would not be time-
consuming. This also meant that there would be no traveling involved to district locations
(other than Dhahran) and that there would be some flexibility in reaching out to the
respondents. Being familiar with the culture of the organization meant that I already had
a preconception of the conditions and it would be difficult to detach or change pre-
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existing notions, which might be considered an ethical issue. Being an insider may
guarantee easier access and good rapport with the respondents; however, this suggests
that certain relations needed to be maintained. Some of the respondents might consider
participating as a favor to be exchanged for a service later. Perhaps being an outsider
would have been more appropriate, as there would have been a certain degree of distance
and detachment from the research respondents, so that the research could be conducted
with less interference and risk of bias.
4.6.1.2 Data Collection Approach
The questionnaire was adopted as the sole data collection method for the quantitative
approach of this research. This data collection method can assist in identifying common
trends. The data collected from the questionnaire were utilized to answer the research
questions presented in previous chapters. The questionnaire was designed to collect
responses from all three groups of managers (lower-level managers, middle managers,
and senior-level managers). As explained earlier, the managers were selected as research
participants as they are the most familiar with the organizational culture, the implemented
knowledge transfer practices, and critical organizational knowledge within the
organization.
Using online questionnaires has several advantages over paper-based questionnaires.
Online questionnaires reach a large number of respondents across geographic boundaries
in a short period of time, which saves time, and mailing and labor costs (Mulvihill &
Haworth, 2005). Questionnaires are one of the most utilized data collection methods, for
various reasons. Evans and Mathur (2005) have provided a comprehensive outline of all
the benefits of using online questionnaires, which include convenience, ease of data entry
and analysis, technological innovation, timeliness, cost-effectiveness, question diversity,
easiness of following up, controlled sampling, ease of obtaining a large samples, control
of the order of the answers, and obligatory completion of answers. Despite all the added
benefits of an online questionnaire, the main reasons for choosing an online survey in this
research are anonymity, the convenience of being able to reach respondents across
geographic locations, and ease of data analysis. Some of the respondents work in clinics
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located in districts other than Dhahran (as explained earlier). These clinics are located 50
kilometers from the main health care center that was the research setting. The online
questionnaire reached these respondents despite their location, which could not have been
achieved with other data collection approaches such as interviews. In addition, the use of
an online survey software program (Survey Monkey) assisted in simplifying the
questionnaire process, as it offered several formats for asking questions (such as
multiple-choice questions, open-ended test responses, Likert-scale questions, and yes/no
questions), tracking the respondents, generating frequencies, and exporting data to a
Microsoft Excel sheet for analysis.
Despite the advantages associated with using online questionnaires, there are a few
disadvantages worth noting. The potential low response rate was considered a limitation
and a challenge, over which the researcher had limited control. However, to address this
issue, follow-up calls were made, and reminder emails sent to remind the respondents to
complete the questionnaire. Another disadvantage is the participants’ responses to the
survey questions. The participants might not provide accurate and meaningful responses,
as they might scan through the questions, focusing solely on completing the survey.
Another concern is that some respondents would provide random answers due to
boredom or miscomprehension of the questions. To address these concerns, the online
survey was designed to enable participants to stop at any time during the process, save
the answers, and resume completing the survey later at their convenience. In addition,
pilot testing was employed to identify whether the questions were too lengthy or unclear.
4.6.1.3 Questionnaire Design
Multiple factors need to be taken into consideration when designing a research
questionnaire, as explained by Edwards (2010). These factors include: the number of
questions, the type of questions (open vs. closed), the order of the questions, the time
spent to complete the survey, the survey appearance or layout, the language, the mode of
administration, and most importantly, the survey platform or online survey tool.
Designing an accurate survey results in accurate data, which is why it is important to
spend time structuring the survey that will be utilized for collecting and obtaining rich
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data. Survey Monkey was utilized as the online survey tool due to its convenience, user-
friendliness, and familiarity. To gain a high response rate and encourage respondents to
complete the survey, it was important to keep the survey simple, the questions clear, and
to limit the survey completion time to 10 minutes. The introduction to the survey clearly
stated that it was anonymous and would take about 10 minutes to complete. The research
questionnaire is available in Appendix 2. The time allocated to complete the survey was
not accurate and was not enough, which was indicated by some respondents during the
pilot survey. The survey introduction had clear directions and presented the topic being
studied and the aim of the research. Simple, basic English language was used to avoid
any confusion or misunderstanding of the questions, as English is not necessarily the first
language of some of the respondents. This was tested during the survey pilot stage.
The online questionnaire comprised 16 questions, divided into four sections. The
questions were categorized into small groups to keep the survey simple and to refrain
from visually overwhelming the respondents. Sixteen questions were not quite enough to
obtain a comprehensive and detailed view of the health care organization’s culture and
knowledge transfer practices, which is why a second data collection approach was
necessary and completed subsequently.
The first section of the questionnaire, consisting of a set of six questions (1 to 6), was
used to collect general demographic data about the respondents. In section two, questions
7, 8 and 9 address the level of management. Section three included two closed-ended
questions and one Likert-scale question. Questions 10 and 11, the closed-ended
questions, identified the respondents’ understanding of the organization’s mission and
vision, which helped assess the respondents’ basic organizational knowledge. Question
12 is a 5-point Likert-scale question, which includes 16 statements concerning
perceptions and attitudes towards the organizational culture. Section four included two
closed-ended questions, one Likert-scale question, and one open-ended question. The two
closed-ended questions, questions 13 and 14, aimed to assess the satisfaction level with
the organization’s knowledge transfer practices. Question 15 is a 5-point Likert-scale
question that includes statements that aim to assess the significance of 13 knowledge
transfer practices implemented in the organization. The last question, question 16, is an
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open-ended question that asks the respondents to explain the reason behind their rating in
question 15.
4.6.1.4 Pilot Survey
A pilot survey is defined as a trial test of a research tool (Baker, 1994). Conducting a pilot
study assists in pre-testing the research study and provides a general overview of the
research’s overall progress and identifies potential risks and issues in the research methods
(Van Teijlingen & Hundley, 2002). The data collection method utilized in this study was a
self-administered online questionnaire. A frequent challenge with questionnaires is that
respondents commonly misinterpret questions (Hunt, Sparkman, & Wilcox, 1982).
Therefore, pilot testing would include testing the survey. Questionnaire pretesting focuses
on detecting survey question flaws and checking whether the questions are clearly
understood by the respondents. According to Bryman (2008), piloting confirms that both
the research questionnaire and the research tool are operating well. Pilot testing was
essential in this research, as a self-administered questionnaire was utilized as the data
collection method, where the researcher is not present to ensure that the questions are clear
and comprehensible (Bryman, 2008).
Other elements that should also be pretested include the survey length, the overall layout,
the question formats, and the flow of questions. Another significant factor to consider
during the pilot testing process is the respondents. When pretesting, it is recommended that
the testing respondents are similar to the target respondents (Tull & Hawkins, 1976). The
comments provided by the testing respondents during the pilot step would be utilized to
improve the overall quality of the questionnaire.
All the factors mentioned above were taken into consideration when conducting the pilot
survey. However, the only element that was a challenge was identifying testing respondents
who were similar to the actual respondents. I was not able to find managers as testing
respondents. Therefore, for the purpose of pretesting, experienced senior employees were
selected, as they were the most knowledgeable regarding the cultural values of the
organization. The literature was inconsistent regarding the size of the pretest sample. This
suggests that the pretest sample size is not fixed. As such, ten employees were selected for
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pretesting the survey, as a sample of 10 seems adequate and applicable to this research
study.
The pilot testing was conducted one month prior to the actual distribution of the
questionnaire, as this would allow enough time to complete the pilot testing. The
questionnaire was sent to the testing respondents via email and they were asked to
complete the survey. The web link that redirects the respondents to the online
questionnaire was pilot tested to ensure that it was working correctly and to avoid
technical problems during the data collection stage. Eight of the 10 employees responded
and answered the survey. Afterwards, the survey questions were discussed with the
respondents via a phone call to ensure that the questions were comprehensible.
The questionnaire received an overall good response. One of the respondents commented
that 10 minutes was not enough to complete the survey. However, if the time was extended
to 15 minutes, the respondents would be demotivated to complete the survey. Another
respondent recommended changing the language of some of the questions, as they were
somewhat difficult to comprehend. After the pretesting stage, the time was not changed,
but the language of some questions was adjusted to a much simpler language. The last step
in the pretesting process is pretesting the data analysis procedure, which was not completed
due to time constraints. Time was a major constraint in this research study.
4.6.1.5 Research Implementation
A list of the research participants was obtained from the health care database system prior
to the start of the data collection stage. The list included all the managers from all the
departments in the hospital; there were 138 managers at the time of the research. The data
collection stage was divided into three phases: introduction, survey distribution, and
follow-up. In the first stage, an email was drafted, which included an introduction to the
research and an invitation to participate in the survey (see Appendix 1). This stage is
important to familiarize the participants with the research being conducted in the
organization, prepare the respondents for the questionnaire distribution phase, and get
their initial approval to participate. An email was sent to all 138 of the research
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respondents one week prior to sending the survey, to inform them of the research
objectives and get their initial approval to participate.
The survey was sent to all the respondents via email, which included the web link to the
research questionnaire. The data collection timeline was three months, which commenced
in June 2015 and ended in August 2015, which was during the summer. Three months
was initially considered to be sufficient, as it would allow more time to complete the
questionnaire, which would lead to a higher response rate. However, it was summer and
most of the respondents were on vacation.
The final phase was the follow-up phase, which was mainly for following up with the
respondents and reminding them to complete the survey. Both reminder calls and emails
were utilized to increase the response rate. Calls and emails had to be made several times
to be able to reach the respondents and remind them of the survey.
Eighty-one participants completed the online questionnaire, resulting in a response rate of
59%, which is relatively low, but generally acceptable. The relatively low response rate
might be attributed to the duration and the timing of the data collection stage. Most of the
managers were on vacation at the time the questionnaire was distributed. It is important
to acknowledge that the researcher was constrained by time and dates during the data
collection stage. Therefore, choosing different dates, extending the time period, or
choosing a different data collection approach were not options.
4.6.1.6 Data Analysis
The organization has requested that its identity remain anonymous. Therefore, the data
analysis process was completed solely by the researcher without assistance, using basic
Microsoft Excel, as SPSS was exceedingly difficult to obtain at the time the research was
conducted due to changes in management and the laborious approval processes. It was
initially intended to do more descriptive statistical analysis, but due to time constraints and
lack of resources, that was not possible or feasible.
The quantitative approach includes identifying key results which are presented,
interpreted, and discussed in a logical and analytical manner (Labaree, 2009). The
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numerical data results were used to populate a table in an Excel sheet, from which
common themes were later identified after reviewing the results. The questionnaire
results were collected using an online survey tool, Survey Monkey, and then downloaded
into an Excel sheet, which was utilized to analyze the extracted data.
Microsoft Excel was utilized as the statistical data analysis tool in this research, as SPSS
was unattainable at the time the research was conducted. Descriptive statistics were
implemented through the analysis of “one variable at a time and is referred to as
univariate analysis” (Patel, 2009, p. 3). Univariate analysis was utilized in this research to
explore variables such as age, gender, and the highest level of education. This analysis
assisted in outlining the overall demographic representation of the sample group.
Descriptive statistics were utilized to describe the research group’s characteristics and
link their perceptions concerning organizational culture with knowledge transfer
practices. Cross-tabulation was used to better understand the survey results. Cross-
tabulations allow the researcher to identify interrelations between variables (Klees, 2017).
The Likert-scale results were categorized into three groups: positive, neutral, and
negative. The positive category represents a combination of the statements that were
rated “agree” and “strongly agree,” the neutral category represents the statements that
were rated “neutral” responses, and the negative category represents a combination of the
statements that were rated “disagree” and “strongly disagree”. English was the
participants’ second language; therefore, the comments and text responses in the
questionnaire contained many typographical errors and many words were misspelled.
However, to give the text authenticity (Collis & Hussey, 2013), I have decided not to edit
the text.
4.6.1.7 Phase One Limitations
The most challenging part of phase one was gathering the research data. The process took
long, because most of the respondents were on vacation and unreachable at the time the
research was conducted.
Quantitative research requires a large sample size to be able to generalize the results. This
research was conducted during a period when several managers were on vacation. As
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such, a large-scale research study was unfeasible and, as a result, the obtained research
results cannot be generalized to a large population.
The research proposal was presented and explained to the members of the senior
management team. The explanation included the study scope, the methodology, the main
objective, and the expected outcomes. This assisted in gaining access, management
approval, and management buy-in to conduct the research. However, in some cases
accessibility was an issue. Management was constantly changing, especially the lower-
level management. The research plan had to be presented on multiple occasions to
different managers requesting their cooperation and response.
A quantitative methodology was employed in the first phase of this research. One of the
limitations of using a quantitative research methodology is the complete neglect of an
individual’s experiences, where individuals are considered as objects that simply react
and respond to their environment (Cormack, 1991). In addition, upon reflection, it was
realized that the collected data were not as rich and diverse as was originally intended.
This can be attributed to the fact that managers were chosen as the sample population.
When investigating the impact of organizational culture on knowledge transfer, it was not
sufficient to have managers as the only research respondents. The employees needed to
be part of the sample group to obtain a proper understanding of the knowledge transfer
process and the organizational culture values. Involving the health care workers and
getting their opinions on the organizational culture and implemented knowledge transfer
practices would have yielded richer and better data. Moreover, incorporating a qualitative
research approach, such as face-to-face interviews, would be beneficial and vital to
understand the various dimensions of the health care organization’s culture and its impact
on knowledge transfer practices. These were the main reasons that led to implementing
phase two, which employed a qualitative research methodology.
This research focused on gaining an understanding of behaviors and social activities
displayed in the organization’s culture and exploring their impact on complex
organizational processes such as knowledge transfer, in a health care setting.
Incorporating a qualitative approach assisted in gaining a much more profound
72
understanding of the organizational culture attributes and the interconnectedness of these
attributes with the knowledge transfer practices implemented in health care. The
qualitative research approach utilized in phase two of this research will be discussed in
the next section.
As explained earlier, the researcher is currently working in this organization and has
managed to establish a good relationship, trust, and rapport with almost all the
respondents. The sample population, as presented earlier, consists of senior-level
managers, middle-level managers, and lower-level managers. Managers, especially
senior-level managers, were usually exceedingly busy and lacked the time to complete
surveys. However, the managers wanted to assist with collecting as many responses as
possible by sending the questionnaires to as many employees as possible. The
questionnaire was indeed sent to other employees within the organization without the
knowledge or consent of the researcher. As a result, the research questionnaire was
completed by participants who were not part of the sample population, as suggested by
the research results, which will be discussed in the next chapter.
4.6.2 Phase Two: Qualitative Research
4.6.2.1 Sample Selection
Two departments (A & B) were selected for the qualitative research process. Each of
these departments employ more than 60 employees. According to Saunders, Lewis and
Thornhill (2012), for semi-structured interviews, the sample size should be between five
and 25. Five employees were selected from each of the two departments. A total of 10
employees were identified to participate in this study. Department A employs non-
clinical employees and performs administrative tasks and support functions in office
spaces away from the main hospital building. Department B employs mostly clinical
professionals, who work in hazardous areas, such as laboratories, in the main hospital
building.
The researcher selected participants working in Dhahran, as they were easier to access in
terms of location. The two concepts, knowledge transfer and organizational culture, that
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were discussed during the interviews are not industry-specific, and the researcher
intended to gain insights from participants from two different disciplines, occupying
different jobs (clinical and non-clinical).
The main purpose of this qualitative approach was to investigate the perceptions of the
employees in different departments, occupying different jobs (clinical and non-clinical).
With the intention of achieving this distinction, the researcher classified the participants
into two categories: clinical (jobs of a clinical nature such as laboratory technologists,
pharmacists, respiratory therapists, etc.) and non-clinical (administrative jobs of a non-
clinical nature such human resource analysts, business specialists, administrative
assistants, etc.).
As mentioned in the previous section, the researcher works in the health care organization
where the research was conducted. A good relationship and rapport had already been
established with most of the respondents.
4.6.2.2 Data Collection Approach
The qualitative research approach is interpretive in nature. Interviewing was adopted as
the qualitative data collection approach to obtain a comprehensive understanding of the
organizational culture factors that impact on the transfer of knowledge. The key
advantage of interviews is that they offer an understanding of specific areas of
individuals’ lives and social worlds (Warren, 2002). Interviews are also utilized to collect
data on the behaviors and perceptions that individuals share (Collis & Hussey, 2009),
which serves the purpose of this research, as it aims to understand employees’
perceptions and attitudes towards organizational culture and knowledge transfer.
Compared to quantitative data collection approaches, qualitative interviews are less
structured and include follow-up questions (Bryman, 2004). Using a semi-structured
interview, as opposed to a structured interview, gives the interviewer some flexibility in
the interview process and allows for further investigation and probing for more
information by asking follow-up questions (Miller, 1995), specifically open-ended
questions. During interviews, the interviewer can ask questions that require respondents
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to share and reveal an event or situation they have experienced in their lives (Mason,
2006).
4.6.2.3 Designing the Interviews
The online questionnaire utilized in phase one was designed based on the literature
review findings, to identify the organizational culture factors that impact on the
knowledge transfer process. Subsequently, the semi-structured, one-on-one interview
questions were designed based on the online questionnaire results and analysis, to enable
the participants to express their opinions and perspectives on the organizational culture
factors and other elements that inhibit or influence the knowledge transfer process. The
key themes that emerged from the responses collected from the questionnaire were
utilized to construct the interview questions. The results obtained from the interviews
were later checked with the results from the interviews to check if there were
correlations.
Ten employees from two different departments were interviewed. Semi-structured
interviews included 15 questions, with the intention of gaining a more in-depth
understanding of two main concepts: organizational culture and knowledge transfer. The
questions were designed to allow the interviewees to express their opinions and provide
thorough answers which would result in a better understanding of the two main concepts.
Some questions were removed, and others were altered during the interview process,
depending on the discussion pace and the responses obtained.
One of the main challenges was maintaining the pace and flow of the interview process
and focusing on answering the interview questions. The first section of interview
questions was concerned with collecting general data from the interviewees, such as job
title, department, number of years in the current organization, number of years in health
care, and highest level of education obtained. The second section included questions
related to the culture of the department, while the third section was directed at knowledge
transfer approaches, motivation factors, and barriers.
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Ten semi-structured, one-on-one interviews were conducted in two different departments
that were selected as part of this study. The rationale for choosing interviews as the research
instrument was two-fold: first, the interviews were used to check whether a correlation
exists between the organizational factors that impact on knowledge transfer that were
identified by the questionnaires and the responses collected during the interviews; and
second, the interview were used to identify any other factors that were not extracted by the
questionnaire. The second reason was to give the interview participants the opportunity to
express their opinions regarding the culture of the organization and the knowledge transfer
practices implemented at their workplace. The participants also gave their input on the
factors that hinder and motivate the transfer of knowledge.
4.6.2.4 Pilot Testing
A pilot interview was performed prior to conducting the interviews. Conducting a pilot
interview gives the researcher the opportunity to collect feedback and to assess whether
the questions asked during the pilot interview are valuable and sufficient to get the
required data and information to answer the research questions and achieve the research
objectives (Taylor, Sinha & Ghoshal, 2006). Four employees, two from each department
(A & B), participated in the semi-structured pilot interview. The original list of interview
questions included 25 questions. It was noted that 30 minutes was not enough to cover all
25 questions during the interview process. In addition, the researcher realized that the
language utilized in the questions was unclear and slightly too complicated for the
participants. The collected feedback and comments were taken into consideration and the
questions were restructured and reorganized and simpler language was used. A brief
overview of phase one’s quantitative research results was added to the introduction to the
interview process, to capture the interviewees’ attention and interest. A simple guide was
also added to the interview introduction, explaining the interview process, to avoid any
confusion or misinterpretation. In addition, some of the questions included in the original
set of interview questions were long, repetitive, and leading. Based on the feedback
collected from the participants during the pilot testing, the number of questions was
reduced from 25 to 15 and some of the questions were restructured.
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4.6.2.5 Research Implementation
All the participants were initially contacted by phone; all 10 accepted the invitation to
participate in the study. The call was followed by an email that explained the research
objectives, the intended outcome, and the participants’ role in the process. The email and
phone call highlighted that the interview was strictly confidential, and anonymity would
be maintained throughout the entire research process, which included the data collection,
analysis and storage. All the identified participants immediately accepted the invitation to
participate and all the interviews were completed within three weeks. The participants
were given the choice of interview location for their convenience (Clarke, 2006). An
audio recorder was used to record the interviews. However, some participants were not
comfortable talking while the audio recorder was on. Therefore, the audio recorder was
used to record only some of the interviews. The researcher had to take notes during the
interview process to allow for precise verbatim transcription of the interviews.
Being an employee in the same organization and in one of the departments where
participants were sourced gave the researcher the advantage of being able to identify the
employees or participants who were most suitable for this research. The researcher shares
the same culture as some of the participants, which suggests that the researcher has a
profound understanding of the situations at the workplace and the knowledge transfer
approaches implemented. Since the researcher was a colleague of the participants, this
allowed for a much more relaxed interviewing atmosphere and elevated the level of
openness, honesty, and participation. However, bias is considered a risk element in such
cases.
The interviews were conducted mainly in English; however, seeing that Arabic is the
mother language of all participants, the conversation during the interviews kept on
switching back and forth between English and Arabic. Some participants felt more
comfortable sharing their experiences in Arabic and the researcher allowed this to
encourage openness. To ensure validity, the researcher repeated their answers in English
to confirm the correctness and accuracy of the responses.
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4.6.2.6 Data Analysis
The data collected during the semi-structured interviews were analyzed using an
inductive approach. Saunders et al. (2012) have explained that there is no standard
approach to analyzing qualitative data. The data that were collected during the qualitative
study was transcribed and analyzed manually by the researcher. Qualitative data analysis
included the descriptive approach, which involves an assessment and examination of the
most common responses. According to Thorpe and Holt (2008), inductive approaches
enable the researcher to describe the individual’s attitudes and understanding in a social
setting. The inductive approach coincides with the exploratory nature of this research
study.
No software tools were utilized during the data analysis process and the major themes
identified from the interview process were categorized and coded manually. The data
analysis process started by first classifying the data collected and assigning unique codes,
which were determined by the emerging trends. Classifying the data into codes enables
the researcher to identify emerging themes and analyze them accordingly (Saldana,
2012). Using the coding technique to analyze data enables the researcher to manage the
data that were collected during the interview process (Auerbach & Silverstein, 2003).
Some codes were mainly driven by the two main concepts of this research, organizational
culture and knowledge transfer, while other codes were identified based on the most
common words the participants used during the interviews.
During the quantitative research carried out in phase one, the researcher was able to cover
a wider range of respondents from the large sample population. The qualitative research
conducted in phase two enabled the researcher to collect more in-depth data from the
smaller sample group. Utilizing two data collection approaches facilitated cross-checking
of the various perceptions that emerged from the questionnaires and the interviews. In
addition, the researcher managed to search for any similarities and variances in opinions
between the managers and the employees.
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4.6.2.7 Phase Two Limitations
The main research limitation, which was considered an ethical issue as well, was the
researcher’s bias. As mentioned in the quantitative section, the researcher worked in the
organization where the research was conducted. Complete detachment and full
objectivity were therefore not possible (Eisner, 1993). As an employee of this
organization, the researcher could easily become too involved in the interview process
and might influence the participants and affect the interview results. However, to
overcome this limitation, the researched data were discussed with the researcher’s
mentor. Since full detachment could not be achieved, the researcher kept on reminding
herself of the importance of self-control and to remain distant and detached, to avoid
influencing the participants during the interview process. During the interview, the
participants kept on changing the discussion and switching topics. It was particularly
challenging to keep the participants focused on answering the interview questions. Some
of the participants were afraid to answer difficult questions and were slightly hesitant to
express their opinions and talk about their personal experiences, despite the trust that
existed. Some participants were afraid to talk with the audio recorder on. It was important
to be sensitive and accommodate the participants’ requests and concerns. Accordingly,
the participants had to be reminded that the interviews were strictly confidential, and their
identities would not be revealed.
Despite all the limitations, the most challenging aspect was finding participants and
arranging the interviews. One of the most challenging responsibilities of the researcher
was to encourage the participants to find time and ensure that they were willing and
comfortable to be interviewed. Finding a suitable location and time was more difficult
than anticipated, mainly because of the participants’ work schedules. Telephone
interviews were even considered as an option at some point during the process, due to
time constraints, workloads, and other commitments. Despite the limitations, the
participants were exceedingly cooperative and committed to supporting the researcher
and managed to set aside time for the interviews. Another extremely challenging task was
encouraging the participants to speak, express their options, and share their personal
experiences during the interview process. The researcher had to ask multiple probing
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questions and give examples on several occasions during the interviews to encourage the
participants to start talking.
4.7 Ethical Considerations
The main concerns of this organization were anonymity and security. It was important to
the management of the organization that all data were treated as strictly confidential and
appropriately secured. To address these ethical concerns, the survey included a statement
regarding anonymity. The respondents were ensured that their identity would remain
anonymous and the answers would be treated as strictly confidential and would not to be
shared with individuals from senior management. The researcher also assured
participants multiple times during the interviews that the shared information would be
considered strictly confidential. Participants completing the questionnaires were not
asked for specific personal information such as their names, identification numbers, or
any other data that could reveal their identities.
The researcher was given permission to record the one-on-one interviews by some of the
participants. Obtaining their permission was increasing challenging, as for some
participants it led to a degree of discomfort, which might disrupt the general atmosphere
of the interview. Discretion and confidentiality were assured at all stages of the
interviews. The collected data were protected and secured in a safe place. All the
participants were reassured repeatedly that access to the data would not be granted to
anyone. All responses, discussions, comments, answers, and shared experiences were
analyzed by the researcher and were shared with the researcher’s academic advisor for
research purposes only. The researcher was willing to share the results of the study with
the participants, but no one asked for the final results of the research. In addition, good
relationships had already been established with the respondents, so that trust was not an
issue. The respondents did not enquire about the storage of the collected responses and
data storage was not a problem in this research. For some of the research participants,
data storage and security were a cause for concern. The participants, especially the
managers, had to be reminded continuously that the collected data were properly stored
and secured.
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One significant challenge and ethical dilemma was the fact that the researcher was an
insider and part of the organization. Being an insider-researcher can be considered a
positive element, since the researcher is more familiar with the research setting and is
more aware of the workplace culture, employees, and any unique situations. However,
being an insider-researcher could lead to subjectivity and bias, which is an ethical
dilemma. During the data interpretation process, a level of self-control was crucial to
prevent bias. On numerous occasions the researcher had to remind herself that she is an
insider-researcher, to prevent her from voicing her thoughts and opinions regarding the
organization. It was imperative to refrain from having her experience affect the
discussion and interpretation of the collected data.
4.8 Discussion and Conclusion
In conclusion, this chapter described the research philosophy, the approaches, the
designs, and the rationale considering the research questions. The research study aimed to
explore the impact of organizational culture on the transfer of knowledge and a
quantitative research strategy was utilized for this purpose. The research was initially
conducted using a deductive method through a quantitative data collection approach,
followed by an inductive method through a qualitative data collection approach. All data
collection tools used during this research study, the completed questionnaires and
interviews, were analyzed manually during the data analysis process. Confidentiality and
privacy were always assured.
The research study’s main strategy was to identify the factors through quantitative
research and to follow up with an in-depth investigation of these factors through
qualitative research. The strategy comprised a self-administered online questionnaire sent
to the organization’s managers, as phase one, and semi-structured interviews with
employees, as phase two. The key intent was to identify the organizational culture factors
that impact on knowledge transfer. The questionnaire and interview questions, as part of
the quantitative and qualitative research, included statements and questions that aimed to
identify these factors. The study targeted both managers and employees to get their
perceptions on the two concepts of organizational culture and knowledge transfer.
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As mentioned earlier, this research is unique in nature, as it took place in a health care
organization in Saudi Arabia. It is important to acknowledge that not many studies are
available in the literature that study organizations in health care settings, or in Saudi
Arabia.
Contextual factors were encountered during the course of the research process. As with
any organization, several changes in management occurred during the course of the
research. This resulted in numerous changes among the managers and their level of
management. This affected the research sample’s demographic results in phase one.
Another major challenge pertaining to the continuous change in management was
accessibility and buy-in. The research proposal had to be presented multiple times, on
several occasions, to different management panels, to get their buy-in and access the
necessary resources to conduct the research.
The following chapter will outline and discuss the results obtained from the research
methodologies employed that included both quantitative and qualitative research
approaches. In the results and discussion chapter, the research results will be associated
with the literature that was reviewed and presented in Chapters 2 and 3. Concluding
remarks and future recommendations will be presented in the final chapter.
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Chapter 5: Research Results and Discussion
Is There a One-Size-Fits-All Approach to Knowledge Transfer in Organizations?
5.1 Introduction
The main objective of this research study is to identify the impact of organizational
culture on knowledge transfer practices in health care. This is achieved by investigating
the organizational culture factors that impact on knowledge transfer and highlighting the
most significant methods to transfer knowledge in a health care organization.
Understanding the culture traits of the organization and the knowledge transfer practices,
as perceived by the respondents to the research, is imperative to achieving the research
objectives, as presented in the introductory chapter.
This chapter presents the research findings and explores the themes that emerged from
interpreting the collected data from the questionnaire and the interviews. No software
tools were utilized during the data analysis process. The data obtained from the survey
were analyzed using descriptive statistics and the interview results were categorized and
coded manually, and the key themes were identified. The chapter discusses the findings
and emerging trends from the analysis of the quantitative survey of the 81 survey
responses collected from the managers in the health care organization. The chapter also
discusses the qualitative results collected from the interviews with 10 employees in the
same health care organization. The results and findings from both methods were then
compared and discussed to check if there were correlations.
This chapter is divided into three sections. The first section presents the results of phase
one, the quantitative research results. The second section discusses the results of phase
two, the qualitative research. The last section closes with a summary and interpretation of
the obtained results and their overall significance for this research study. The first and
second sections provide overall information pertaining to the research samples and
discuss the research results of each phase and the analysis of the obtained data. The
demographic details pertaining to the research respondents are presented, as these are
significant to the discussion of knowledge transfer. This chapter highlights the
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organizational culture factors that impact on the transfer of knowledge in health care and
the knowledge transfer methods utilized to communicate the mission and vision within
the organization. The respondents’ attitudes towards the organization culture are
presented and discussed. The chapter also explores the knowledge transfer practices
implemented in the organization and identifies the drivers of, and barriers to, knowledge
transfer.
5.2 Phase One: Quantitative Research Results
5.2.1 Research Respondents
The online questionnaire, using Survey Monkey, was sent to all 138 managers from
various departments in the hospital. They were given four weeks to complete the survey,
and occasional verbal and email reminders were issued. A total of 81 respondents
completed the research questionnaire, leading to a response rate of 58.7%, which was
much higher than initially anticipated. The main challenge with this method was that
there was no specific way of knowing who had accessed the online questionnaire, as it
was anonymous. This posed the risk of having the survey completed by individuals who
were not targeted for this research. However, the demographic questions included in the
survey assisted in addressing this issue. The next section discusses the respondents’
socio-demographic details.
5.2.2 Demographics
The research respondents’ demographic details are presented and discussed in this
section, which provides an overview of the research participants and an introduction to
the research findings presented in the following sections. Table 5.1 presents a summary
of the respondents’ demographic profiles.
Demographics Details Frequency Percentage
Gender Female
Male
37
44
45.68%
54.32%
Nationality Saudi
Non-Saudi
51
30
63.00%
37.04%
Highest level of
education
Bachelors
Doctorate/PhD
34
13
41.98%
16.05%
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High School
Higher Diploma
Masters
Other
3
10
19
2
3.70%
12.35%
23.46%
2.47%
Number of years of
experience in the
current organization
0-5 6-10
11-15
16-20
21-25
26-30
31-35
14
8
12
28
9
4
6
17.28%
9.88%
14.81%
34.57%
11.11%
4.94%
7.41%
Worked for other
organizations
Yes
No
40
41
49.38%
50.62%
Work location
Abqaiq
Dhahran
Hasa
Ras Tanura
5
70
4
2
6.17%
86.42%
4.94%
2.47%
Table 5.1 Summary of the Research Respondents’ Demographic Details (N=81)
5.2.2.1 Gender
The distribution of responses between females and males was almost equal, with slightly
more males, comprising 54.32%, than females, comprising 45.68% (Table 5.2). This
distribution was expected, as the research was conducted in a hospital setting, where
management was not restricted to a specific gender.
Gender Percentage
Female 45.68%
Male 54.32%
% 100%
Table 5.2 Respondents’ Gender
5.2.2.2 Nationality
The hospital where the research was conducted includes employees of various
nationalities, ethnicity, and socio-economic status, but the largest number of employees
are Saudis. A total of 63.00% of the respondents were Saudis and 37.04% were non-
Saudi. The research was conducted in Saudi Arabia, which explains why the majority of
the managers were Saudis. Fifteen different nationalities are represented in the hospital,
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as displayed in Table 5.3. This results in a multicultural organizational setting, which, on
the one hand, might result in a rich knowledge transfer and sharing environment. On the
other hand, this cultural diversity might also result in communication issues due to
language barriers. Such communication-related obstacles and work and cultural diversity
could affect employee performance and productivity if not managed properly.
Nationality Percentage
Saudi 63.00%
Non-Saudi 37.04%
% 100%
Table 5.3 Respondents’ Nationality
5.2.2.3 Worked for Other Organizations
Having worked for other organizations suggests knowledge flow and mobility across
organizations (whether in health care or not). The respondents were asked a closed-ended
question regarding whether they had worked for other organizations. Respondents were
expected to answer “yes” if they had worked for other organizations and to indicate what
type of organization and to answer “no” if they had not.
The results were close to equal, with 50.62% of respondents answering “no” and 49.38%
of respondents answering “yes”. Out of these 49.38%, 77.50% had previously worked for
health care organizations and 22.50% had previously worked for non-health care
companies (as presented in Table 5.4). This suggests that 49.38% of the employees have
new knowledge and experience to share; this group would be considered excellent
candidates for knowledge transfer programs, depending on the knowledge that they
possess.
Employee mobility and movement is a powerful way to transfer experience and
knowledge across organizations. When individuals move to a new organization, their
experience and acquired knowledge move with them. This new organization needs to
have an optimal working environment that adopts a knowledge transfer culture to
encourage and motivate new employees to transfer their knowledge. This is particularly
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important in health care, where clinical and medical practices can be transferred, which
can lead to improved organizational outcomes and more effective patient care.
Worked for Other
Organizations
Percentage
Yes 49.38%
No 50.62%
% 100%
Table 5.4 Respondents Who Had Worked for Other Organizations
5.2.2.4 Number of Years of Experience in the Current Organization
The respondents were asked to answer an open-ended question regarding the number of
years of experience in the current organization. Their answers were categorized into
seven groups: 0–5 years, 6–10 years, 11–15 years, 16–20 years, 21–25 years, 26–30
years, and 31–35 years (Table 5.5). The majority had worked for the organization for
between 16 and 28 years (34.57%); this might suggest that most of the managers or
respondents were experts in their areas of specialty. Respondents who have been working
in the hospital for more than five years are expected to be truly familiar with the
organizational culture. Respondents with more than 11 years of experience are expected
to have a deep and profound understanding of the organizational culture. It is important
to know the respondents’ years of experience in the current organization, as this serves as
an indicator of their level of familiarity with the organization’s culture and its mission
and vision. In addition, these respondents would be considered the best target to
participate in knowledge transfer activities.
Years of Experience in The
Current Organization
Percentage
0-5 17.28%
6-10 9.88%
11-15 14.81%
16-20 34.57%
21-25 11.11%
26-30 4.94%
31-35 7.41%
Table 5.5 Respondents’ Years of Experience in Current Organization
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5.2.2.5 Level of Education
The results reveal that 66 of the respondents have educational degrees (34 have a
bachelor’s degree, 19 have a master’s degrees, and 13 have PhD/doctorate degrees) and
the other 15 respondents have either a high school diploma, a higher diploma, or another
type of certificate or diploma. These numbers indicate that 81.48% of the respondents are
educated and are expected to be knowledgeable, and 39.51% of the respondents have
graduate degrees (23.46% are master’s degree holders and 16.05% are PhD/doctorate
degree holders), as presented in Table 5.6.
Highest Level of
Education Frequency
Percentage
Bachelors 34 41.98%
Doctorate/PhD 13 16.05%
High School 3 3.70%
Higher Diploma 10 12.35%
Masters 19 23.46%
Other 2 2.47%
Table 5.6 Respondents’ Highest Level of Education
5.2.2.6 Work Location
The majority of the respondents worked in Dhahran (86.42%), while the rest of the
respondents worked in the districts, namely Abqaiq (6.17%), Hasa (4.94%), and Ras
Tanura (2.47%) (Table 5.7). The reason for this is that the main hospital building and all
the specialty services are located at the main health care clinic in Dhahran, while small
clinics are available in the three districts.
Work Location Percentage
Abqaiq 6.17%
Dhahran 86.42%
Hasa 4.94%
Ras Tanura 2.47%
Table 5.7 Respondents’ Work Location
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5.2.2.7 Management Level
Respondents were asked to disclose their current management level and choose one out
of three answers: senior management (report to C-Suite), middle management (one level
between the respondent and C-Suite), and lower management (more than one level
between the respondent and C-Suite). The results indicate that 17.28% were senior
management, 39.51% were middle management, and 43.21% were lower management;
most of the respondents fit into the last category (Table 4.8).
Management Level Percentage
Senior 17.28%
Middle 39.51%
Lower 43.21%
Table 5.8 Respondents’ Management Level
Gender Female Male
Total Management Level Low Middle Senior Low Middle Senior
Diploma 1 1 0 4 3 1 10
Masters 2 5 2 3 4 3 19
Bachelors 15 7 1 4 7 0 34
High School 1 0 0 1 1 0 3
PhD 0 0 1 3 3 6 13
Other 1 0 0 0 1 0 2
Total 20 13 4 15 19 10 81
Table 5.9 Cross-tabulation of Management Level, Highest Level of Education, and
Gender
The senior-level managers numbered 14, of which 10 were male and 4 were female.
Middle-level managers numbered 32, of which 19 were male and 13 were female. Lower-
level managers numbered 35, of which 15 were male and 20 were female. These data
suggest that senior and middle-level managers were predominantly male. A cross-
tabulation was established to investigate the relationship between the respondents’
gender, education, and management level. According to the results displayed in Table
5.9, no link exists between education, gender, and management level. The increase in the
number of males in middle and senior management positions can be attributed to either
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the organizational culture or the national culture of Saudi Arabia, which is considered a
masculine society.
Years of experience include practical or technical knowledge and the acquired skills over
a specified period. Is there a relationship between the number of years of experience and
the management level? Table 5.10 represents the relationship between management level
and years of experience. According to the table, 34.57% of managers at all three levels
have 16 to 20 years of experience. It was noted that 17.28% of managers have less than
five years of experience and 7.41% of managers have more than 30 years of experience.
Three of the managers who occupy senior-level positions have less than five years of
experience and no managers with more than 30 years of experience occupy senior-level
positions. According to the table, no relationship exists between the years of work
experience and the management level. This suggests that an increase in years of
experience does not necessarily translate into a higher management position, so that other
factors might be involved.
Years of Experience
Management Level
Percentage Lower Middle Senior Total
0-5 6 5 3 14 17.28%
6-10 5 2 1 8 9.88%
11-15 6 5 1 12 14.81%
16-20 11 11 6 28 34.57%
21-25 1 5 2 8 9.88%
26-30 3 1 1 5 6.17%
31-35 3 3 0 6 7.41%
Table 5.10 Cross-tabulation between Management Level and Years of Experience
5.2.3 Number of Reports
The next two questions pertained to the number of reports and were in the form of open-
ended questions. The respondents were asked to state the number of employees that they
manage, directly and indirectly. The rationale behind these questions was to identify the
number of employees that the respondents were responsible for. According to The
Economist (2009), the number of employees represents the span of control, which varies
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from one department/service to the other. The span of control depends on several factors
and assists in gaining a better understanding of an organization’s structure.
Another reason for including these questions in the questionnaire was to confirm that the
respondents were indeed managers. As stated earlier, there was no method to identify the
survey respondents, as it was anonymous. In addition, the researcher was unable to
follow up with all the respondents or to resend the survey due to time constraints and
changes that the organization was encountering during the period of data collection. An
open-ended question was chosen as opposed to a closed-ended question, to obtain an
unstructured response from the participant. On the one hand, this might assist in
understanding the behavior or attitude of the respondent by avoiding suggested responses.
On the other hand, coding open-ended questions is challenging compared to closed-ended
questions.
Most respondents answered this question with a numerical value indicating the number of
employees. Some respondents provided text answers, some of the responses were “few”,
“no direct reports always”, “during relieving time for 48 staff members”, “depends on
what assignment I was assign”, “nil”, “none”, and “zero”. Eleven respondents out of 81
provided an answer indicating that they have no employees directly reporting to them.
This suggests that either the question was not clear, and the respondent gave an
inaccurate answer or an employee (not a manager) had completed the survey. This might
indicate that 13.58% of the respondents were not in management positions, while 86.42%
of the respondents held managerial positions. This problem was anticipated when the
online questionnaire was initially sent to the respondents.
The next open-ended question asked respondents to state the number of employees that
they indirectly manage. Indirect reports are employees who are indirectly managed by a
supervisor. Managers are responsible and accountable for their direct as well as indirect
reports. This question serves the same purpose as the previous question. Twenty-seven of
the respondents answered “0” or “none”. The same issue encountered with the previous
question applies to this one. This suggests that either employees (not managers)
responded to this question or that the respondents, who are managers, do not have any
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indirect reports. This might indicate that 33.33% of the respondents do not occupy
managerial positions or do not have indirect reports.
After thoroughly examining the results of both survey questions, the following
observations were identified regarding the group of respondents:
• Some of the research respondents do not occupy managerial positions.
• The questions were not clear to some of the respondents, as some respondents
provided the same answer to the two different questions.
5.2.4 Transfer of Organizational Knowledge (Mission and Vision)
This section explores the employees’ knowledge of the organization’s mission and vision
and the preferred knowledge transfer method utilized to communicate this knowledge
across the organization. This section also addresses the second research question, which
is to identify the knowledge transfer mechanisms that are most effective when
transferring critical knowledge (mission and vision) within organizations. The
organization’s mission and vision are significant in determining the success of the
organization. Management plays a crucial role in transferring and cascading
organizational knowledge to the employees across an organization, ensuring this will
contribute to a positive organizational culture where the organizational core values,
which include the mission and vision, are distributed and understood by all the
employees.
The two questions concerning the organization’s mission and vision targeted two groups.
The first group were the managers, or the respondents, and the second group were their
employees. Two types of questions were utilized. Closed-ended questions asked if the
organization’s mission and vision were clear to both the managers and their employees
and open-ended questions inquired how the mission and vision were communicated to
both the managers and their employees. These questions were intended to answer the
second research question, which is to identify the most effective knowledge transfer
mechanisms to communicate and transfer critical organizational knowledge, such as the
mission and vision, across health care organizations.
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Transfer to the Respondents
This question targeted the respondents as managers. The results were unexpectedly
positive, as most managers (88.89%) believed that the organization’s mission and vision
were clear, while 11.11% believed that they were not clear, as presented in Table 5.11.
Response Frequency Percentage
Yes 72 88.89%
No 9 11.11%
Table 5.11 Clarity of the Mission and Vision to the Respondents
The open-ended free-text comments were analyzed to extract a common theme. The
results revealed that the three highest methods utilized to transfer the organization’s
mission and vision were emails, posters, and meetings. Other means of communication
utilized for the same purpose included the company website, workshops, and
symposiums.
Some of the answers suggest that the question was not clear enough to some of the
respondents, since some provided random answers and others did not answer the
question. Twenty-nine out of 52 did not answer the open-ended question and two
respondents gave answers that were irrelevant to the question, namely “4” and “one”.
Some respondents provided meaningful responses that do not necessarily serve the main
purpose of the question. However, these comments did give an idea of the overall
organizational culture, as perceived by some of the respondents, such as: “The JV
between big oil company and big medical center and research must meet the patients’
expectation with the highest quality services they are waiting to receive.”
The next section pertains to the respondents’ employees. The questions asked the
managers if they believed that the mission and vision were clear to their subordinates and
to state the method of communication utilized for this purpose.
Transfer to the Respondents’ Reports (Employees)
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This question asks the respondents, the managers, if they believe that the mission and
vision are clear to their employees. This question assists in understanding whether the
managers believe that they transferred their knowledge of the organization’s mission and
vision to their employees. This question was also intended to give an overall
understanding of the organizational culture. Principally, the managers need to ensure that
the organization’s mission and vision have been communicated and transferred to the
employees. A method to ensure that the employees are properly engaged within the
organization is through effective communication of the mission and vision.
In this section, the respondents were asked to state whether the mission and vision were
clear to their subordinates: 60.49% responded “yes”, 8.64% answered “no”, and 30.86%
replied “I don’t know” (Table 5.12). These results suggest that 56 managers were
confident that their employees understood the organization’s mission and vision and 32
managers were either not confident or were not sure whether their employees understood
the mission and vision. This suggests that there might be a communication issue between
some of the managers and their employees.
Response Frequency Percentage
Yes 49 60.49%
No 7 8.64%
I don’t know 25 30.86%
Table 5.12 Clarity of the Mission and Vision to the Subordinates
The follow-up question sought to understand how knowledge of the organization’s
mission and vision was transferred to the respondents’ employees: an open-ended
question asked each respondent to explain how the organization’s mission and vision
were communicated to their staff. According to the results, the top three communication
channels are emails, posters, and meetings. Other means of communication included the
company website, workshops, and symposiums.
It was noted that the responses to all the questions pertaining to the organization’s
mission and vision were similar. This could be attributed to the fact that the managers
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answered on behalf of their staff. Perhaps if the employees had the opportunity to answer
the questions, the responses would have been different. The results of the second section
are in line with the results of the previous section. This suggests that the preferred
methods of communication to transfer critical organizational knowledge from the top
down are emails, posters, and meetings. These results give a brief overview of the
organization’s communication strategy and the knowledge transfer mechanisms
available. Communication is a critical factor to consider when discussing organizational
culture. According to the results, this organization relies on both written (emails and
posters) and verbal (meetings) communication to transfer or communicate critical
organizational knowledge across the organization.
5.2.5 Attitude Towards Organizational Culture
The next section sought to understand the overall organizational culture of the selected
health care setting. This was achieved by measuring the respondents’ attitudes towards
selected statements pertaining to the culture of the organization (see Table 5.13). A five-
point Likert scale (5 = strongly agree, 4 = agree, 3 = neutral, 2 = disagree, and 1 =
strongly disagree) was utilized for this purpose and followed by an open-ended question
to provide additional comments. A rating scale was selected to measure the respondents’
perceptions of and attitudes towards the organizational culture. The statements in this
question were identified after an extensive literature review of organizational culture
dimensions, presented in Table 5.13.
Question
No. Strongly Agree Agree Neutral Disagree Strongly Disagree
Q1 The organization encourages employees to be innovative and take initiatives
% 15.00% 50.00% 25.00% 6.25% 3.75%
N 12 40 20 5 3
Q2 The organization’s goals are realistic
% 8.64% 45.68% 30.86% 12.35% 2.47%
N 7 37 25 10 2
Q3 The organization values and utilizes each individual’s unique strengths and
different abilities
% 6.17% 46.91% 25.93% 17.28% 3.70%
N 5 38 21 14 3
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Q4 The department/unit has clearly defined goals that align with the
organization’s main goals
% 11.10% 55.56% 22.22% 11.11% 0%
N 9 45 18 9 0
Q5 Employees are adaptable to changes within the organization
% 4.94% 53.09% 28.40% 8.64% 4.94%
N 4 43 23 7 4
Q6 Organizational changes are poorly communicated to the employees
% 10.00% 30.00% 35.00% 18.75% 6.25%
N 8 24 28 15 5
Q7 Meeting the needs of customers/patients is considered the highest priority
% 27.50% 48.75% 11.25% 11.25% 1.25%
N 22 39 9 9 1
Q8 Employees are encouraged to work in teams
% 23.46% 48.15% 20.99% 7.41% 0%
N 19 39 17 6 0
Q9 Customers/patients are considered each employee’s responsibility
% 30.86% 51.85% 12.35% 4.94% 0%
N 25 42 10 4 0
Q10 Employees’ personal goals are aligned with the organization’s mission and
vision
% 6.17% 44.44% 33.33% 14.81% 1.23%
N 5 36 27 12 1
Q11 Employees have open access to information regarding the organization’s
performance
% 4.94% 41.98% 23.46% 28.40% 1.23%
N 4 34 19 23 1
Q12 Management demonstrates concern for the welfare of employees
% 12.50% 41.25% 26.25% 12.50% 7.50%
N 10 33 21 10 6
Q13 Management consults with employees on issues that affect them
% 8.75% 31.25% 26.25% 21.25% 12.50%
N 7 25 21 17 10
Q14 Employees are encouraged to provide honest feedback to one another
% 14.81% 48.15% 25.93% 8.64% 2.47%
N 12 39 21 7 2
Q15 Employees are empowered to do their jobs
% 17.28% 48.15% 22.22% 9.88% 2.47%
N 14 39 18 8 2
Q16 The organization provides incentives to motivate employees to perform
% 8.64% 34.57% 22.22% 27.16% 7.41%
N 7 28 18 22 6
Table 5.13 Reponses to Organizational Culture Statements
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SA = Strongly Agree, A = Agree, N = Neutral, D = Disagree, SD = Strongly Disagree
Figure 5.1 Attitudes Towards Organizational Culture
The overall responses pertaining to organizational culture were mainly positive. Results
indicate that 27% of the respondents strongly agree that “meeting the needs of patients is
of highest priority,” while 50% agree that “the organization encourages employees to be
innovative and take initiatives,” 30.86% were neutral regarding “the organization’s goals
are realistic,” 27.16% disagreed with “the organization provides incentives to motivate
employees to perform,” and 12.50% strongly agreed that “management consults with
employees on issues that affect them.”
The results suggest that the statement that received the highest positive responses (which
includes a grouping of “strongly agree” and “agree”) amongst the respondents was
“meeting the customers’/patients’ needs is the highest priority.” By comparison, the
statement that received the highest negative responses (which includes a grouping of
“strongly disagree” and “disagree”) amongst the respondents was “The organization
50%
46% 47%
56%53%
30%
49% 48%
52%
44%42% 41%
31%
48% 48%
35%
25%
31%
26%
22%
28%
35%
11%
21%
12%
33%
23%26% 26% 26%
22% 22%
6%
12%
17%
11%9%
19%
11%
7%5%
15%
28%
13%
21%
9% 10%
27%
0%0%
10%
20%
30%
40%
50%
60%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Attitude Towards Organizational Culture
SA A N D SD
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provides incentives to motivate employees to perform.” This suggests that the
organization has a customer-oriented culture where the emphasis is mainly on meeting
the customer’s or patient’s needs, which is expected in any health care organization.
Health care organizations need to focus on meeting the patients’ needs and the
organization’s strategic priorities, mission, and vision should clearly reflect a
commitment to patient care. Having a strong culturally competent organization that
focuses on the patients’ needs is critical when undergoing organizational changes. The
results suggest that the organization is not providing any incentives to motivate its
employees.
Years of Experience
This section explored the difference in perceptions of organizational culture between
novice, entry-level employees (≤ 5 years of experience) and expert, mastery-level
employees (≥ 20 years of experience). The statement that received the highest positive
rating amongst experienced employees was “meeting the customers’ needs is the highest
priority.” The statement that received the highest positive rating amongst the less
experienced employees was “Customers/patients are considered each employee’s
responsibility.” The two statements share the same concept or meaning, which is the
importance of customer service or patient care. This suggests that all employees,
regardless of years of experience, share the same commitment and obligation to patient
care in particular and the health care field in general. The only perceived difference is
that expert employees regarded patient care from a broader organizational perspective,
while the less experienced employees viewed patient care from a more specific,
individual employee perspective. Expert employees considered meeting the patients’
needs as an organizational goal that starts with the organization as a whole, then cascades
down to the employee. Novice employees perceived meeting the patients’ needs as an
individual goal that is the responsibility of each employee within the organization.
Focusing on customer service and patient care is anticipated and expected in a health care
organization, in which the patients, as the customers, are of the utmost importance.
However, this pledge to patient care merely suggests that the employees have a sense of
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commitment to patient care, not necessarily a commitment to the organization.
Furthermore, this is no indication of a positive organizational culture, which needs further
reflection and investigation.
The statement that received the highest negative responses amongst the novice employees
was “Employees have open access to information regarding the organization’s
performance,” while the statement that received the highest negative responses amongst
the expert employees was “The organization provides incentives to motivate employees
to perform.” Novice employees with limited knowledge and expertise require open access
to knowledge repositories within the organization. According to the results, novice
employees have limited access to information. These employees require access to gain
information and acquire knowledge. By comparison, expert employees with more than 20
years of experience do not need to have access to knowledge repositories to gain
knowledge. They require incentives (internal or external) to transfer their knowledge and
increase their performance level within the organization.
Management Level
This section explored the difference in perception of organizational culture between all
three management levels (senior level, middle level, and lower level). The statement that
received the highest positive responses amongst all three management levels was
“Customers/patients are considered each employee’s responsibility.” This suggests that
all three management levels agree that meeting the customer’s needs is of utmost
importance, which is expected in a health care organization. Organizational management
is responsible for developing goals that revolve around patient care and cascading these
goals to the employees. It is the responsibility of the managers to ensure that employees
are held accountable and responsible for achieving these goals. This assists in creating a
culture of accountability and ownership in the organization that focuses on patient care.
The statement that received the highest negative response amongst both middle- and
lower-level managers was “the organization provides incentives to motivate employees to
perform.” Middle- and lower-level managers manage employees and report to senior
managers and are not involved in organizational level decision-making. According to
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Table 5.5, 34.57% of the managers have 16 to 20 years of experience. This suggests that
they have acquired rich knowledge and expertise and require incentives (internal or
external) to transfer this knowledge and increase their performance. Senior managers’
results were different than those of the other managers, with “Management consults with
employees on issues that affect them” receiving the highest negative response. This
suggests that senior management perceives employee engagement and communication to
be an issue, as indicated by one of the respondents: “There is lack of communication
between the management and staff are not aware of the cahnges occuring [sic].” This
might affect the culture of the organization and performance.
5.2.6 Attending Educational Courses
This section explored the organization’s commitment to continuous employee
development, which affects the overall organizational culture and adds to the
organizational knowledge repository. For this question, there was an almost equal
division between the responses, with no significant variation. However, the results leaned
slightly to the negative side, with 51.85% responding “no” to the question whether they
had attended an education course in the last three months and 48.15% responding “yes”
(Table 5.14). If the answer was “yes,” the respondents were asked to indicate how many
courses they had attended and whether these were work-related. Most of the answers
suggested respondents had attended one course and that it was work-related. Not all
respondents answered this question: 44.44% provided answers and 55.56% did not. Two
or three respondents indicated that the educational course had been online. At the time of
the research, the organization’s focus was on the organization’s new strategic values and
business direction. Therefore, it was expected that employee training and development
would not be a business priority at that stage of the research.
Response Percentage
Yes 48.2%
No 51.9%
Table 5.14 Attended Courses in the Last Three Months
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5.2.7 Satisfaction with Knowledge Transfer (KT) Practices
This section addressed the knowledge transfer practices in the organization. Question 14
sought to understand whether the respondents are generally satisfied with the knowledge
transfer practices implemented in the organization. This question assisted in
understanding the respondents’ overall views regarding knowledge transfer practices.
The number of respondents who are satisfied with the knowledge transfer practices in the
organization is higher than the number of respondents who are dissatisfied: 56%
responded “yes” and 43.21% responded “no” (Table 5.15). However, the number of
dissatisfied respondents was still reasonably high, especially amongst the lower-level
managers (40%) and middle-level managers (42.86%), when compared to the senior-level
managers (17.39%) (see Table 5.16). The follow-up question might help to understand
the reason behind these results, as it can help identify some of the factors that drive and
hinder knowledge transfer. Unfortunately, 48 respondents did not answer the question;
however, a sufficient number of comments were provided to identify a common theme.
Response Percentage
Satisfied with KT practices 56.79%
Dissatisfied with KT
practices 43.21%
Table 5.15 Satisfaction with KT Practices
Management Level
Satisfaction with KT
Practices Senior Middle Lower
Satisfied 17.39% 36.96% 45.65%
Dissatisfied 17.14% 42.86% 40.00%
Table 5.16: Cross-tabulation between Satisfaction with KT Practices and Management
Level
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5.2.8 Factors Affecting Knowledge Transfer
Question 14 was followed by an open-ended question, where the respondents were asked
to indicate the reason behind their answer and had the option to add their remarks and
comments concerning the knowledge transfer practices in the organization. This section
explored the “why” behind respondents’ satisfaction or dissatisfaction with the
knowledge transfer practices in the organization. Understanding the reasons assisted in
identifying the factors that affect knowledge transfer in the organization. This section
addressed the first research question, which concerns identifying the organizational
culture factors that affect the transfer of knowledge in the organization. Mahmudi and
Kargaran (2016) have stated that identifying and eliminating the barriers to knowledge
sharing is important for organizational success. “Knowledge transfer” is occasionally
used interchangeably with “knowledge sharing” (Jonsson, 2008). Therefore, it can be
suggested that overcoming the barriers to knowledge transfer and perhaps amplifying the
drivers can result in organizational success.
Common factors or themes were identified by analyzing the comments provided by the
respondents. The comments were categorized into three groups: knowledge transfer
drivers, knowledge transfer barriers, and both. Table 5.17 presents the main factors that
affect the transfer of knowledge in the organization.
Knowledge Transfer Drivers Knowledge Transfer Barriers
Motivation to transfer knowledge Shortage of staff
Management
Generation gap
Knowledge Transfer Barriers and Drivers
Communication
Knowledge transfer resources
Knowledge transfer process
Table 5.17 Factors that Impact Knowledge Transfer
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In light of the results, seven factors were identified as organizational culture factors that
affect knowledge transfer, and these can be categorized as drivers, barriers, or both.
Communication was recognized as the most significant factor, as it was considered both a
facilitator and a barrier to knowledge transfer. Knowledge transfer resources and the
knowledge transfer process were other factors that were identified as both drivers and
barriers to knowledge transfer. The only acknowledged facilitator of knowledge transfer,
according to the respondents, was having a motivation to transfer knowledge. Staff
shortages and generation gaps were identified as barriers to knowledge transfer.
Management was also perceived as one of the barriers. The following section discusses
the identified organizational culture factors that affect the knowledge transfer process,
divided into three sections: factors that both facilitate and hinder knowledge transfer,
factors that facilitate knowledge transfer, and factors that hinder knowledge transfer.
1. Factors that Facilitate and Hinder Knowledge Transfer (Drivers and Barriers)
The following factors were perceived as both barriers to and drivers of knowledge
transfer, with some of the respondents providing positive and others negative comments
pertaining to these factors, which include communication, knowledge transfer resources,
and the knowledge transfer process.
Communication
Based on the respondents’ comments, communication was perceived as a critical factor in
transferring knowledge. Most of the respondents’ comments pertained to communication.
Some respondents elaborated on the positive impact of communication on knowledge
transfer as a driver and other respondents considered communication a barrier to
knowledge transfer in their department. Below are some of the comments and reasons
that were provided by the respondents; these indicate that effective and efficient
communication is important in knowledge transfer:
• “NEW INFORMATION EFFECTIVELY COMMUNICATED.”
• “we have good communication system.”
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The above comments suggest that having an effective communication system or strategy
is an important factor in transferring knowledge and information across the organization.
An effective communication plan can include both verbal and written communication
approaches. An effective communication strategy is of significant importance in any
organization. Critical knowledge and information need to be communicated to all
employees in an effective and timely manner.
However, some respondents perceived communication as a barrier to the knowledge
transfer practices implemented in their department, as indicated in the following
comments:
• “lack of communication of courses.”
• “although I am supervisor not all information are filtered down. Still hear
things via the grapevine.”
• “But in certain areas communication on specifics could be much clearer eg.
CN role.”
• “The changes are made then employees will be notified.”
Apparently, clear and open communication is imperative: knowledge needs to be
transferred effectively and information is expected to keep flowing successively and
without interruption in the organization. The above comments suggest that all the
respondents agree that there is an issue with the communication process in the
organization; however, each respondent had a different interpretation of what constitutes
communication in the organization. In some departments, such as nursing, the role of the
charge nurse (CN) is not clearly defined and communicated to the employees. There also
seems to be a lack of communication of organizational changes, as explained by one of
the respondents. Managers are facing communication issues, as some information is not
being “filtered down.” Communication can sometimes be perceived as an issue for the
employees who work in the health care clinics located in the districts (Abqaiq, Hasa, and
Ras Tanura). These employees are sometimes unintentionally disregarded or overlooked
in the organization’s key communication events, such as town hall meetings held by
corporate management and knowledge transfer activities, as these take place in the main
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clinic in Dhahran. Occasional technical difficulties hinder the process of transmitting
these events and meetings to the districts.
In addition, communication was also perceived as a barrier to the process of knowledge
transfer in the organization. Some of the respondents identified communication as both a
potential barrier to and a facilitator of knowledge transfer. Lack of communication or
lack of transparency in communication was considered a major issue in the organization,
as it holds critical implications that can affect both the organization and employees. The
comments presented in this section verify this finding. The research was conducted at a
critical time when the organization was experiencing some significant changes. Having
an effective communication strategy is the primary facilitator of knowledge transfer
within the organization and it is particularly significant during a change management
process. In addition, investing in a centralized knowledge or data repository system is
critical at such times to preserve organizational knowledge and store all the information,
to be able to retrieve it when needed, which is particularly important in health care.
The Transfer of Knowledge Process
The process to transfer knowledge was the second factor that was perceived as both
positive and negative. The following comments indicate that the organization has a good
knowledge transfer process:
• “good processes in place for the area.”
• “Knoledge is perfectly transfered with my department.” [sic]
A systematic process of knowledge transfer is required for the effective transfer of
knowledge within an organization. An effective knowledge transfer process depends on
various factors, embedded in four stages, as stated by Chan and Ford (2003): generation,
codification, sharing, and application. The respondents were generally satisfied with the
overall knowledge transfer process and described it as “good” and that knowledge in the
department was “perfectly transfered” [sic]. This could indicate that all four stages of
knowledge transfer are properly implemented in the organization. The “good” process
could also be attributed to various factors such as having an effective IT system, a
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training program, a clearly defined process of knowledge transfer, and a trusting working
environment, or could be a combination of all factors.
By contrast, some respondents were not pleased with the knowledge transfer process in
their department and the organization. The following comments suggest that the process
of knowledge transfer almost does not exist in the organization or their department:
• “no formal knowledge transfer process as it has been a very challenging time for
the organization.”
• “it is not clear.”
• “Somewhat.”
• “minimal only.”
• “Ther is no knowledge transfere at all.” [sic]
The results from question 14 and the above comments suggest that the organization has a
knowledge transfer issue. A proper system to transfer knowledge is necessary to facilitate
the knowledge transfer process. The organization needs to have a robust and structured
knowledge transfer process to rely on for sustainability and success. This lack of a formal
framework can perhaps be attributed to the fact that the organization was going through
changes.
Knowledge Resources
Proper utilization of the available knowledge transfer resources is important, as it impacts
on the overall knowledge transfer process in the organization. The following comments
suggest that there are various resources for acquiring knowledge in the organization:
• “new comers always assigned to senior staff to provide on job training in addition
to online and other guidelines available to perform the job. for other employees,
the available resources (books, online material, and JHI support) to perform task
is sufficient to complete the tanks. Also rotational assignments will increase
employee knowledge.” [sic]
• “Sharing knowledge to co workers.”
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Some of the knowledge resources mentioned were hands-on job training, online
resources, policies and guidelines, communities of practice, the organization’s US
counterpart, and senior staff. These resources suggest that the organization has
knowledge resources for the two types of knowledge, tacit and explicit. The comments
also suggest that there is a knowledge-sharing environment, which can be considered the
optimum setting for knowledge transfer activities.
The above comments indicate the availability of various knowledge resources within the
organization. However, the following comments reveal that these knowledge resources
have not been adequately utilized in all departments
• “There is no proper training session.”
• “lack of communication of courses.”
• “Was hoping to transfer … Knowladge.” [sic]
Some departments are not utilizing the available knowledge resources, as specified by
one of the respondents: “hoping to transfer … Knowladge [sic].” Some departments are
not aware of the resources available in the organization, as indicated in this statement:
“lack of communication of courses.” All of these factors hinder the knowledge transfer
process. One respondent mentioned that “there is no proper training;” this suggests that
important job-specific training courses do not exist in the organization or the department.
The availability of knowledge resources can be considered an influencing factor for
knowledge transfer; however, it can also hinder the transfer of knowledge if not utilized
or not utilized adequately.
2. Factors that Hinder Knowledge Transfer (Barriers)
This section discusses the barriers to knowledge transfer as proposed by the respondents.
Three factors were identified as factors that hinder the transfer of knowledge in the
organization, namely the generation gap, management, and staff shortages.
Generation Gap
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The respondents believe that a vast intergenerational gap exists, which is perceived as a
barrier to knowledge transfer. The results obtained from question 3 suggest that there is a
huge a generation gap in some departments, as reflected in the following statements by
some of the respondents:
• “There is a big gap between gnerations working in the division.” [sic]
• “There is a big gap between generations of emplyees.” [sic]
The generation gap was considered a barrier to the knowledge transfer process in the
organization, as stated by some of the respondents. A generation is a “group of
individuals with shared experiences and common values” (Mohr, Moreno-Walton, Mills,
Brunett & Promes, 2012, p. 1). Therefore, a generation gap refers to the difference in
values, experiences, and cultural norms between two generations (McCready, 2011) and
concerns the management of human resources (Shen, 2016). Failing to manage
intergenerational gaps affects the knowledge transfer process and impacts the overall
success of the organization (Shen, 2016). Intergenerational conflict can be the result of
poor communication and other organizational issues (Arsenault, 2004). Intergenerational
collaboration is essential, and it might be important for managers to employ processes
that meet the needs of various generations of employees.
The demographic results suggest that there are many experienced employees within the
organization. These experienced employees can leave the company at any time, taking
away their valuable knowledge. Transferring their knowledge is important at this stage, to
avoid losing significant knowledge. Organizations needs a knowledge transfer strategy to
bridge the generation gap (Novianto & Puspasari, 2012). The experienced employees
might be reluctant to transfer their knowledge and need to be encouraged. Motivating
employees to transfer knowledge is discussed later in this chapter. In this organization,
knowledge in relation to generation gaps can be perceived as an excellent opportunity to
implement knowledge transfer programs. Knowledge transfer can also assist in bridging
the gap across different generations. However, this aspect of knowledge transfer needs to
be further explored.
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Management
Some respondents indicated that management has a negative impact on the knowledge
transfer process, as mentioned in the following comments:
• “A lot of changes, a lot of paper works, revision of papers. A lot of bosses to
follow.”
• “Management is not tranparant.” [sic]
• “Sometimes there is no transparency between upper management and
employees.”
• “Absence of policies and procedures.”
According to the comments, a lack of transparency is one of the major issues with
management. This issue exists at various management levels and hinders the transfer of
knowledge in the organization. The results suggest that this can be attributed to the lack
of transparency in communication by management. The employees’ trust in managers is a
serious issue (Ngambi, 2011). The way leaders communicate and treat their employees
during difficult times impact the level trust (Kasper-Fuehrer & Ashkanasy, 2001) and
morale (Ngambi, 2011). Lack of transparency by managers might suggest a lack of
direction, which leads to issues in organizational performance, demotivation, distrust, and
loss of employee morale (Berggren & Bernshteyn, 2007), which can also affect the
overall organizational culture.
One respondent mentioned that there are “a lot of bosses.” This suggests that there are
many management levels in the organization structure. This indicates that several
approval levels are required to approve a process or policy, which results in delays. This
might explain why there is an “absence of policies or procedure.” Multiple levels in an
organization result in overall slow information dissemination and an inflexible
organizational system that impedes the implementation of critical processes such as
knowledge transfer. This negatively impacts the communication and transfer of
knowledge within this organization.
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Shortage of Staff
Staff shortage is a critical issue, especially in health care organizations. As mentioned
above, staff shortages can result in decreasing employee morale and performance
(Robbins, 2003). The results to question 3 suggest that a large percentage of the staff
population is aging and retiring soon. This indicates that even more employees will be
leaving the organization. Respondents provided comments regarding staff shortages as
follows:
• “manpower restraints and increased unrealistic demands.”
• “Staff shortage limits the amount of time that can be spent on knowledge
transfer.”
• “turnover is too fast so the process has short time.”
• “Shortage of staff doesn’t support to have such an activity.”
Staff shortage is perceived by the respondents as a barrier to the knowledge transfer
process. This can be anticipated, as it results in less time allocated to knowledge transfer.
Shortage of staff in this organization is due to normal attrition, but an increase in
employee turnover can result in a severe shortage of health care professionals.
Implementing a structured knowledge transfer process to retain critical medical and
organizational knowledge is imperative, given the changes that the organization was
going through.
3. Factors that Influence Knowledge Transfer (Drivers)
The following section represents the factor that facilitates knowledge transfer, as
perceived by one of the respondents. Only one factor was identified as a knowledge
transfer driver in the organization, namely the motivation to transfer knowledge.
Motivation to Transfer Knowledge
Employee motivation can be considered as a significant factor in knowledge transfer
(Cruz et al., 2009). In the following comment, the respondent mentioned that knowledge
transfer was “encouraged” in the department and the organization. However, the
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respondent also added “but done mostly on employee initiative.” This suggests that the
respondent was referring to intrinsic motivation, and not extrinsic motivation as a driver
to transfer knowledge, as stated below:
• “This is encouraged but done mostly on employee initiative.”
In this organization, intrinsic motivation is essential to amplify and encourage the
knowledge transfer process. However, the organization cannot rely solely on employees
being intrinsically motivated to transfer knowledge; extrinsic motivation must be
considered in some cases or reinforced by management. In this particular context, it is
crucial to identify who are the knowledge sources or holders (the experienced
employees), the knowledge recipients (the novice employees), and the type of knowledge
to be transferred (tacit knowledge). Encouraging experienced employees to transfer their
tacit knowledge and experience by participating in a structured, formal knowledge
transfer process requires different motivational approaches, which can be considered an
excellent research topic to explore in future studies.
5.2.9 Knowledge Transfer Practices
This section focuses on the knowledge transfer mechanisms implemented in the
organization. The main purpose of this section is to identify the most significant
knowledge transfer mechanisms, as perceived by the respondents. The statements listed
in Table 5.18 are a compilation of all the knowledge transfer practices implemented in
the organization. The statements were derived after an extensive literature research of all
the knowledge transfer practices that exist in health care organizations. Thirteen
knowledge transfer practices were identified and are summarized in Table 5.18.
Knowledge Transfer Practices
Shadowing other employees
Reviewing the unit’s operating manuals, policies and procedures
Socializing and interacting with other staff members within the unit
Interacting with staff members outside the department
Attending lectures, courses and seminars
Accessing online resources
Regular communication with the supervisor
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Short-term assignments in other departments within the organization
Asking guidance from experienced senior employees
Enrolling in continuing education programs/courses
Networking internally within the organization
Networking externally outside the organization
Interacting with external consultants
Table 5.18 Knowledge Transfer Practices
The respondents were asked to specify their level of agreement with the importance of
the knowledge transfer practices implemented in the organization. A five-point Likert
scale (5 = strongly agree, 4 = agree, 3 = neutral, 2 = disagree, and 1 = strongly disagree)
was utilized for this purpose, followed by an open-ended question to provide additional
comments. A rating scale was selected to measure the respondents’ perceptions of the
knowledge transfer practices implemented in the organization.
The results, presented in Table 5.19, suggest that 50.62% of the respondents strongly
agree that “regular communication with the supervisor” is an important knowledge
transfer practice and 56.79% agree with the importance of socializing with other staff
within the unit as a knowledge transfer practice. Only 27.16% were neutral regarding
interacting with staff outside the department as a knowledge transfer practice, 11.11% of
respondents disagree with shadowing other employees as a knowledge transfer practice
and 3.7% strongly disagree with both shadowing other employees and consulting external
consultants as knowledge transfer practices.
Strongly Agree Agree Neutral Disagree Strongly Disagree
Q1 Shadowing other employees
% 29.63% 40.74% 14.81% 11.11% 3.70%
No. 24 33 12 9 3
Q2 Reviewing the unit’s operating manuals, policies and procedures
% 32.91% 53.16% 8.86% 5.06% 0.00%
No. 26 42 7 4 0
Q3 Socializing and interacting with other staff members within the unit
% 29.63% 56.79% 12.35% 1.23% 0.00%
No. 24 46 10 1 0
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Q4 Interacting with staff members outside the department
% 19.75% 45.68% 27.16% 7.41% 0.00%
No. 16 37 22 6 0
Q5 Attending lectures, courses and seminars
% 48.15% 45.68% 4.94% 1.23% 0.00%
No. 39 37 4 1 0
Q6 Accessing online resources
% 38.27% 53.09% 6.17% 2.47% 0.00%
No. 31 43 5 2 0
Q7 Regular communication with the supervisor
% 50.62% 43.21% 6.17% 0.00% 0.00%
No. 41 35 5 0 0
Q8 Short-term assignments in other departments within the organization
% 26.25% 51.25% 15.00% 5.00% 2.50%
No. 21 41 12 4 2
Q9 Asking guidance from experienced senior employees
% 44.44% 50.62% 3.70% 1.23% 0.00%
No. 36 41 3 1 0
Q10 Enrolling in continuing education programs/courses
% 44.44% 44.44% 7.41% 3.70% 0.00%
No. 36 36 6 3 0
Q11 Networking internally within the organization
% 38.27% 46.91% 12.35% 2.47% 0.00%
No. 31 38 10 2 0
Q12 Networking externally outside the organization
% 34.57% 41.98% 20.99% 2.47% 0.00%
No. 28 34 17 2 0
Q13 Interacting with external consultants
% 34.57% 43.21% 17.28% 1.23% 3.70%
No. 28 35 14 1 3
Table 5.19 Responses to Knowledge Transfer Statements
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SA = Strongly Agree, A = Agree, N = Neutral, D = Disagree, SD = Strongly Disagree
Figure 5.2 Attitudes Towards Knowledge Transfer Practices
The survey results pertaining to the knowledge transfer practices in the organization were
categorized into three categories: positive (a grouping of the “agree” and “strongly agree”
responses), neutral, and negative responses (a grouping of the “disagree” and “strongly
disagree” responses) as presented below.
Positive Responses
In general, all the statements received positive responses. This indicates that all the
respondents agree that all the knowledge transfer practices listed are important. However,
the knowledge transfer methods that received the most positive responses were “regular
communication with the supervisor” and “asking guidance from experienced senior
employees.” The results concur with the previous results that emphasize the importance
of communication in the organization, particularly with the managers.
0%
10%
20%
30%
40%
50%
60%
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13
%
Statement No.
Importance of Knowledge Transfer Practices
SA A N D SD
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Novice, entry-level employees and expert, mastery-level employees have different
knowledge transfer preferences. Senior more experienced employees considered “asking
guidance from senior employees” to be the most important method to transfer knowledge.
By comparison, the less experienced, novice employees considered “attending lectures,
courses, and seminars” to be the most significant knowledge transfer method. Despite the
difference in their perceptions, both novice and experienced employees agreed that
“regular communication with the supervisor” is an important knowledge transfer practice.
This was the reason behind considering “regular communication with the supervisor” to
be the most important knowledge transfer practice in the organization, which answers the
third research question.
Neutral Responses
Again, all the statements received positive responses. However, one of the statements
received the highest number of neutral responses (27.16%), namely “social interactions
with other employees or staff members outside the department.” Interacting with
employees outside the department and networking can be considered as a convenient,
fast, and informal method to acquire knowledge. It enables the transfer of tacit
knowledge, despite organizational constraints and boundaries across several departments.
Employees can willingly participate in such social interactions without feeling the
obligation or pressure to do so. Networking and increasing contacts between employees
from different departments should be encouraged.
Despite the importance of social interaction, most of the research respondents had a
neutral attitude towards interacting with employees outside their department. There are
various ways to interpret or to explain why the respondents selected a “neutral” response.
To some respondents, the neutral response might be the equivalent of an unsure or
indecisive response. A “neutral” response might also indicate that the respondent does
not understand the statement, or that the statement is too long and the easiest way to
complete the questionnaire is to select “neutral.”
Negative Responses
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Further analysis of the research data indicates that one statement pertaining to knowledge
transfer methods received the least positive responses or the most negative responses,
namely “shadowing other employees” (Table 5.19 and Figure 5.2). Shadowing other
employees can also be referred to as job shadowing. Job shadowing and mentoring
assignments are mainly used to transfer knowledge, skills, and expertise from
experienced senior employees to novice, less-experienced employees (Room, 2012). On-
the-job training is also implemented by organizations, where two employees are paired
together on a formal or informal basis, in which one employee who is less-experienced
shadows the experienced employee, to gain comprehensive job knowledge and hands-on
experience (Room, 2012). Despite the importance of job shadowing for transferring
workplace knowledge, this strategy received the most negative responses from the
research participants. One explanation is the shortage of staff at the time the research was
conducted. The experienced employee does not have enough time to train and transfer
work knowledge to the novice employee. Job shadowing is generally the knowledge
transfer method of choice for new hires. As such, job shadowing was not effectively
utilized as a knowledge transfer method.
5.2.10 Factors Influencing the Significance and Choice of Knowledge Transfer
Practices
The knowledge transfer practices and mechanisms were explored in the previous section.
This section examines the rationale behind choosing a specific knowledge transfer
mechanism. The questionnaire concluded with an open-ended question that asked the
respondents to explain “why” or “what” influenced their decision when rating the
knowledge transfer practices in the previous question. These comments assisted in
understanding the factors that influence the decisions behind selecting a knowledge
transfer practice.
Many of the responses indicated that the most significant factor that influenced
respondents’ decisions was experience. This is reflected in the following comments:
• “from experience”
• “through experience”
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• “based on my experience”
• “experience”
• “Through experience …”
This suggests that experience is essential when considering knowledge transfer
mechanisms. In this context, experience can be interpreted as previous practical
experience that is encapsulated in tacit knowledge.
Respondents recognized the importance of knowledge transfer to employee development
and the organization’s overall existence, as indicated in the following comments:
• “Knowledge transfer is key to employee buy in.”
• “I agree that the above are necessary to promote knowledge transfer …”
• “knowledge sharing is critical to assure continuity of provided services to be
excellent as well as improve employee engagement to the organization. also
employee moral will be impacted as he will be challenged on the work.” [sic.]
One of the respondents considered knowledge transfer an asset, as indicated in the
following comment:
• “Knowledge transfer is an HR asset of the oragnization that we should adapt on
our multipule services.” [sic]
The expectations and significance of knowledge transfer go far beyond the organizational
processes to reach patients’ services and care. Some respondents acknowledged that
knowledge transfer plays an important role in delivering excellent patient care and
improving health care. The respondents recognized the significance of knowledge
transfer in achieving quality services for the customers and patients, as reflected in the
following statements:
• “I do value the importance of knowledge transfer in keeping employee to the up-
to date level and help to provide the highest quality and safest services to our
customers”
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• “these are essential for the success of the organization and for employees
development and satisfaction as well as customer satisfaction with standards of
care.” [sic]
The comments reveal that there might be an issue with the overall culture of the
organization, as indicated in the following statements:
• “As with any new company is facing challenges related to implementing change
in both work and culture. Improved communication and a detailed strategic vision
is important in order to be successful.” [sic]
• “I do not think this happens consistently and accurately.”
• “basically, we need people to reach out to people and change the overall vibe of
the work environment into a positive vibe where people enjoy coming into work
and are appreciated for the efforts they do.”
• “There needs to be support from management.”
• “There is no progress in gaining knowledge in this center and encouragement
from the management in supporting staff is lacking as well.”
• “Transparency, acknowledgment, empowerment of employees and openness are
fundamental criteria in the process of successful organization management”
Interaction and communication were also mentioned as factors that influence the decision
on a knowledge transfer mechanism and its significance. It is necessary to develop a
culture where formal or informal communication is encouraged. This will enable the
open exchange of experiences and knowledge between all individuals from various
departments within an organization. Interaction and communication in its various forms
among all employees is essential in the knowledge transfer process, as suggested by the
following respondents:
• “interaction with other department and colleges” [sic]
• “in additional two way communication between all the team including leaders is
healthy for any organization.” [sic]
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• “Knowledge transfer is extremely important in order to allo experts to share their
knowledge and the learning curve can go both ways between new comers and
experts in the field.” [sic]
• “… it’s became clear to me that the repeated meetings with officials, Short-term
assignments outside the department and Interacting with colleagues and advisers
from outside the organization it helps to speed up the transfer of knowledge.” [sic]
Respondents indicated that the implemented knowledge transfer strategies need
improvement and that all the knowledge resources available in the organization are not
being fully utilized. One of the underutilized resources is collaboration with outside
organizations through external consultants, as indicated in the following statements:
• “I personally believe that we need more input from outside the organization as
this will prevent stagnation”
• “I beleive in being open to outside rescources and other organisations rather than
being disconnected from the outside world” [sic]
• “being open to outside resources”
• “one learn a lot from external consultants” [sic]
• “in Saudi Arabia we are isolated from the rest of the world and by interacting with
external (especially western) consultants it is easier to keep up to date with the
latest Evidence base practices. Face to face is very helpful and should be add to
just networking externally. Consultants can be invited to come and visit us to help
find gabs we can imporve on and advise.” [sic]
The employees have a sense of responsibility and autonomy regarding knowledge
transfer and acquiring education, as indicated in the following statements:
• “I do beleive that each empolyee is responsible about their edcuation and
professional development, unfortunetly knowledge transfer need time and plan of
action and whats more the empolyee himself or herself to be MOTIVATED to get
knowledge, if the emplyee is not ready for such, then knowledge transfer is not
going to happen.” [sic]
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• “Attending lectures and online resources is usually the poorest method for gaining
and retaining knowledge and skills. It is passive learning and if employee is not
highly motivated, the retention rate is poor. Other types are more interactive and
more supportive to various ways of adult learning.”
5.3 Phase Two: Qualitative Research Results
5.3.1 Research Respondents
As mentioned in the previous chapter, face-to-face, semi-structured interviews were used
as the method of data collection. A total of 10 individuals were interviewed, five
individuals (clinical roles) from department A and five individuals (non-clinical roles)
from department B. The participants were asked a few demographic questions and
questions related to organizational culture and knowledge transfer. The following
sections discuss the findings of these interviews.
5.3.2 Demographics
The data collection process was described in the methodology chapter. Bearing in mind
the research questions, the questions covered during the interviews targeted various
components of organizational culture and knowledge transfer. The demographic data
collected from the interviews include nature of the job (clinical or non-clinical), number
of years in health care, number of years in the current organization, highest level of
education, and qualifications achieved so far in the current organization. As with the
previous section, the data, together with the percentages and frequencies, are presented in
the tables below. With reference to the nature of the current job (clinical or non-clinical),
Table 5.20 illustrates that five employees of the 10 interviewees occupy clinical jobs,
representing 50% of all interviewees, and five employees occupy non-clinical jobs,
representing 50% of total interviewees.
Variable No. (n=10)
Clinical job 5 (50%)
Non-clinical job 5 (50%)
Total 10
Table 5.20 Nature of Current Job
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As demonstrated in Table 5.21, three employees have spent a period of 1–3 years in
health care (30%), while one employee has spent 7–10 years (10%), and two employees
have spent more than 10 years in health care. The highest percentage represents
individuals who have spent 4–6 years in health care (40%).
Variable No. (n=10)
0-3 years 3 (30%)
4- 6 years 4 (40%)
7-10 years 1 (10%)
More than 10 years 2 (20%)
Total 10
Table 5.21 Number of Years in Health Care
Table 5.22 reflects the number of years spent in the current organization. The highest
percentage represents individuals who have spent 4–6 years in the organization, which
denotes 50% of the respondents.
Variable No. (n=10)
0-3 years 2 (20%)
4- 6 years 5 (50%)
7-10 years 2 (20%)
More than 10 years 1 (10%)
Total 10
Table 5.22: Number of Years in Current Organization
Table 5.23 presents the highest level of educational qualification. The data indicate that
six of the respondents have a bachelor’s degree (60%), three have a master’s degree
(30%), and one holds a diploma (10%). Table 5.23 indicates that the highest number of
interviewees hold a bachelor’s degree.
Variable No. (n=10)
Bachelors 6 (60%)
Masters 3 (30%)
Diploma 1 (10%)
Total 10
Table 5.23 Highest Educational Qualification
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As part of the study, respondents were asked whether they had obtained any additional
qualification since they started working at the organization. Table 5.24 summarizes the
results to this question; only one respondent had obtained an additional qualification in
the current organization, comprising 10% of respondents.
Variable No. (n=10)
Yes 1 (10%)
No 9 (90%)
Total 10
Table 5.24 Additional Qualifications Obtained in Current Organization
In summary, the demographic data collected from the sample group gave a descriptive
overview of the population. It is apparent that 50% of respondents occupy clinical jobs
and 50% occupy non-clinical jobs, most of whom hold a bachelor’s degree. The highest
percentage of respondents have worked in the organization and/or in health care for a
period of between four and six years. It appears that this organization is the first or
second employer for most respondents. The data also suggest that perhaps not all
employees have had the opportunity for continuous education to obtain additional
degrees or diplomas.
5.3.3 Interview Findings
The primary purpose of the interviews was to reveal the organizational culture factors
influencing the transfer of knowledge. The knowledge transfer approaches implemented
in the workplace were identified and discussed, as well as the transfer of knowledge
related to the organization’s mission and vision. The discussion then proceeded to
highlight both the factors that motivate and those that hinder knowledge transfer.
While two departments (A and B) were targeted for this research to identify any
differences between them, a few common trends emerged. In particular, the interviewees,
both clinical and non-clinical, mentioned similar factors related to knowledge transfer.
The social aspect is a significant element in the knowledge transfer process in this
organization. Another dominant theme to emerge from the interviews is that
management’s attitude and support play a key role in the work culture and the transfer of
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knowledge. This suggests that the organizational culture instilled in team dynamics and
management attitude has an impact on employees’ motivation and willingness to
contribute to the organization through knowledge transfer.
The following sections present and describe the research findings. The results were
analyzed according to two broad themes, organizational culture and knowledge transfer:
1. Organizational culture factors include the work environment and work
relationships, and the impact that these factors have on the transfer of knowledge
and its influence on health care.
2. Knowledge transfer practices include practices implemented in the organization to
transfer knowledge (professional and critical organizational information),
perceived barriers to knowledge transfer, and motivation factors to transfer
knowledge.
5.3.4 Organizational Culture
This section explored organizational culture factors that impact on the transfer of
knowledge. The data suggest that there was a significant difference in the workplace
culture between departments A and B. It was apparent that the interviews succeeded in
highlighting the organizational culture factors, as perceived by the interviewees, by
focusing on their work atmosphere and environment. Positive or negative, the most
common word used by almost all the respondents from both departments when talking
about work atmosphere and organizational culture was “cooperation.” Examples where
the term “cooperation” was mentioned include the following statements:
• “… there are confidentiality, cooperation, and trust issues.”
Department A respondent
• “… no cooperation.”
Department A respondent
• “… Uncooperative environment.”
Department A respondent
• “My team is a little cooperative … The department is not cooperative”
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Department A respondent
• “cooperative.”
Department B respondents
This suggests that all the respondents immediately associated work environment or
workplace culture with the “cooperation” trait or aspect of the work team. It was noted
that the work environment in department B is far more “cooperative” than in department
A, as indicated by the respondents above.
Other words used by some of the respondents to describe the work environment were:
“teamwork,” “competition” or “competitive,” and “friendly.” Some examples include the
following statements:
• “No teamwork.”
Department A respondent
• “friendly, but still.”
Department A respondent
• “Competition is high.”
Department A respondent
• “Family environment … friendly …”
Department B respondent
• “... competitive.”
Department B respondent
The above gives an indication of how the respondents from both departments A and B
define “organization culture” and “work environment”. The elements of cooperation,
teamwork, competition, and friendliness, whether used positively or negatively by the
respondents to describe their work, is an indication of the social aspect of the work
environment.
According to the participants, the work atmosphere in department B (clinical) is more
cooperative and less competitive than the work atmosphere in department A (non-
clinical). Two respondents from department B described the environment as “friendly”
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and “cooperative,” as opposed to the respondents from department A, who described the
environment as “uncooperative” and that there are “trust issues” and “no teamwork”
between the members. This suggests that the work culture in clinical areas is friendlier,
more cooperative, and less competitive compared to the work culture in non-clinical
areas. Is this positive culture attributable to the clinical nature of the jobs in that area and
the relation to patients and health care? Is there a connection between a positive
organizational culture and health care? This research cannot answer these questions and
further research is required to confirm the correlation between health care and a positive
workplace culture.
One of the respondents stated that “My team is a little cooperative. The department is not
cooperative.” In this example, the team that the respondent works with is “a little
cooperative” or cooperative to some extent, while the overall department (A) culture is
not cooperative. This suggests that in some cases there might be a difference between the
team culture or work environment culture and the larger department culture. This might
indicate that the overall organizational culture might not be an accurate representation of
all the departments, divisions, and teams in the organization, where subcultures perhaps
exist.
5.3.5 Organizational Factors that Affect Knowledge Transfer
In order to further understand the respondents’ perceptions of organizational culture and
knowledge transfer, the respondents from both departments were asked to describe the
organizational culture factors that affect knowledge transfer. The organizational factors
that affect knowledge transfer, as indicated by the respondents, can be summarized into
three main factors: the generation gap, communication, and management. The factors
identified in this section coincide with the survey results from phase one and have already
been discussed in the previous section.
• “The significant experience gap affects knowledge transfer and the lack of
communication especially from manager … ‘gossiping’ is also a factor ‘which is
considered bad communication’”
Department A respondent
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• “Communication”
Department A respondent
• “Communication with manager is important but doesn’t exist”
Department A respondent
• “Leadership”
Department A respondent
• “Lack of communication and management”
Department A respondent
• “Manager can positively and negatively impact KT” … “Communication between
manager and employee can go both ways”
Department B respondent
• “manager’s support and knowledge”
Department B respondent
• “Generation gap and manager needs to support KT”
Department B respondent
• “Manager’s knowledge ‘The manager has to be knowledgeable himself or herself’
… The manager needs to have the knowledge”
Department B respondent
• “generation gap ... and managers”
Department B respondent
Two departments, A and B, were targeted to observe any differences between clinical and
non-clinical environments. However, this section identified a few common themes in
both areas. The participants mentioned similar factors at the organizational level in both
departments. The main theme emerging from the interviews was the organizational
factors that impact on the transfer of knowledge. Communication and manager’s support
were identified as major factors that impact on knowledge transfer.
The results suggest that communication and management play a vital role in shaping the
culture of the work environment and the transfer of knowledge. Communication can have
both a positive and a negative impact on knowledge transfer. Communication in the work
environment between employees and their managers could impinge or influence the
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transfer of knowledge. Bad communication, in the form of miscommunication or
“gossiping,” can occur in the workplace and has an adverse effect on knowledge transfer.
Communication issues might be attributed to the generation gap in the workplace.
The responses also suggest that managers are seen as a vital and important factor of the
culture of the work environment: their support provides opportunities to transfer
knowledge and their lack of support is a barrier to knowledge transfer. In the work
environment, managers’ actions, behavior, and attitudes can impede, as well as promote,
the transfer of knowledge. According to the respondents, communication can be
considered a contextual factor that influences or inhibits knowledge transfer. These
findings support the notion that the team environment and communication in the
workplace impact on the transfer of knowledge.
5.3.6 Knowledge Transfer
The respondents were asked to list the approaches implemented in the organization to
transfer professional (work-related), personal (self-development), and organizational
knowledge (mission and vision). The data suggest that the best approach to transfer
knowledge in general is face-to-face interactions, either through meetings, courses,
educational sessions, learning from senior employees, or asking the managers. The results
are an indication of the importance of the social aspect, which complements the results
from the previous phase.
For professional knowledge transfer, meetings appear to be the most preferred knowledge
transfer approach, as stated below. The results in this section coincide with the results
extracted from the survey. The respondents also identified other approaches to transfer
knowledge within their department, as mentioned in the following statements:
• “ask the manager and meeting.”
Department A respondent
• “presentations, meetings, mentoring, partnering, rotation in different areas.”
Department A respondent
• “Asking others, weekly meetings.”
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Department A respondent
• “Information is communicated through friends from other depts, official
meetings.”
Department B respondent
• “Job rotations, weekly meetings.”
Department B respondent
• “Face to Face communication such as weekly meetings. Emails for daily updates.
Learning from Seniors. Should encourage knowledge transfer between hospitals
and exchange knowledge with other hospitals.” [sic]
Department B respondent
For professional knowledge, face-to-face communication was identified as the most
preferred method to transfer knowledge. Asking managers and other more experienced
employees was another important knowledge transfer approach that the respondents
chose. Other knowledge transfer approaches included reaching out to experts from other
departments and other hospitals.
For personal knowledge, the respondents’ preferred choice of approach was courses and
educational sessions, as mentioned in the following statements:
• “Courses.”
Department A respondent
• “Course and workshop.”
Department A respondent
• “weekly/monthly education knowledge transfer session, knowledge transfer with
employees outside dept, our manager is very knowledgeable.”
Department B respondent
• “Face-to-face departmental education sessions.”
Department B respondent
• “Educational face-to-face sessions.”
Department B respondent
• “Knowledge sharing sessions where interesting patient cases are shared.”
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Department B respondent
For personal development and knowledge transfer, the respondents preferred courses and
education sessions that promote the exchange of knowledge in a formal, classroom-based
environment in a less structured and informal manner. To some respondents, having a
competent and knowledgeable manager is important, in order to support personal
knowledge transfer within the work environment. A manager can support employees in
satisfying their personal development by transferring knowledge and creating an
atmosphere that is supportive of knowledge transfer. This is apparent in department B, in
which educational sessions occur. This is most vital in health care, where employees can
transfer clinical knowledge during educational sessions, as mentioned by one of the
respondents from department B: “Knowledge sharing sessions where interesting patient
cases are shared.”
As for organizational knowledge such as the mission, vision, and strategic objectives of
the organization, the respondents’ preferred knowledge transfer approach is meetings;
some respondents added emails, as indicated in the following examples:
• “Meetings.”
Department A respondent
• “Meetings and emails.”
Department A respondent
• “Meetings and from friends in other departments.”
Department B respondent
• “Meetings and emails.”
Department B respondent
• “Weekly meetings.”
Department B respondent
• “For organizational changes, calls and meetings. For organizational updates,
emails.”
Department B respondent
• “Emails, weekly meetings.”
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Department B respondent
Despite all the knowledge transfer practices implemented in the organization, it was
apparent that some of the respondents from department A were not satisfied with the
overall knowledge transfer practices implemented in the organization, compared to the
respondents from department B, as indicated in some of the following statements:
• “It is difficult, no knowledge transfer because people resist to transfer
knowledge.”
Department B respondent
• “Currently, you have to dig for knowledge. It’s not about transferring knowledge.
It’s what you do with the knowledge and how you manage it.”
Department A respondent
• “Doesn’t exist.”
Department B respondent
• “Nothing, no training.”
Department A respondent
• “Barely exists! Organizational knowledge is transferred by force by higher
management.”
Department A respondent
Statements such as the above suggest that some of the respondents are not satisfied with
the knowledge transfer practices that have been implemented and the overall culture of
knowledge transfer in the organization seems to be nonexistent. Some respondents
mentioned that this issue goes beyond knowledge transfer. There seems to be an issue
with the utilization of the transferred knowledge, in the department in particular and in
the organization as whole. This could be attributed to various reasons; these will be
discussed in subsequent sections.
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5.3.7 Motivation to Transfer Knowledge
The results suggest that the respondents recognized the importance of having both
internal and external motivation to transfer knowledge, as reflected in the following
statements:
• “Self-satisfaction and recognition and appreciation are important.”
Department A respondent
• “I like to transfer knowledge. I mean, why not. The organization benefits as whole
… And promotion and position are important, too … Both are important.” [sic]
Department B respondent
• “Both are important. Mostly, internal to see good things. The employee’s success
is my success. I’m not looking for credit. Knowledge changes your perspective.
However, encouragement and support from management such as promotion and
moral support it important.” [sic]
Department B respondent
The above responses indicate that the respondents in both departments A and B are
currently motivated to transfer knowledge by both internal and external factors. Both
external and intrinsic factors are important for the motivation to transfer knowledge.
However, most of the respondents believe that internal motivation is more important for
knowledge transfer than external motivation, as indicated in the following examples:
• “Don’t wait for knowledge to be transferred, you have to search for it.”
Department A respondent
• “Some transfer KT for the wrong reasons- for show off and seeking attention. KT
should be for good reasons.” [sic]
Department A respondent
• “I openly share knowledge.”
Department A respondent
• “Must have the willingness to share knowledge.”
Department A respondent
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• “Sometimes internal is more important than external and manger's support is
essential.” [sic]
Department B respondent
Although intrinsic motivation is not always enough, in this organization, intrinsic
motivation is more imperative than extrinsic motivation. One of the participants
mentioned “self-satisfaction.” This suggests that motivation to transfer knowledge is
intrinsic, as it adds to an individual’s own satisfaction. In addition, intrinsic motivation
can be associated with feelings of solidarity: “other employees’ success is my success.”
One respondent mentioned that “the organization benefits as a whole,” which implies that
some employees have a sense of loyalty towards the organization and are motivated to
transfer knowledge to improve and enhance the organization.
The respondents suggested a few approaches to motivate employees to transfer
knowledge within the organization, as explained in some of the following examples:
• “… managers to take your hand.”
Department A respondent
• “improve general communication first by providing more training and
development courses.”
Department A respondent
• “Offer more development opportunities.”
Department A respondent
• “knowledge transfer tied to reward.”
Department A respondent
• “Management support.”
Department B respondent
• “Manager’s support and encouragement? time?”
Department B respondent
• “Add knowledge transfer to the annual performance evaluation where employees
add a business or development goal related to transfer of knowledge and are rated
at the end of the year.”
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Department B respondent
• “More time to transfer knowledge.”
Department B respondent
According to above statements, the recommended approaches to motivate employees to
transfer knowledge are: 1. management’s encouragement and support, 2. offering more
development courses, 3. linking knowledge transfer to performance evaluation and
reward system, and 4. giving employees time to focus on transferring knowledge. It
appears that the respondents seek to link the motivation to transfer knowledge in the
organization with the organization’s strategic objectives. The employees in both
departments A and B are intrinsically motivated to transfer knowledge and do not expect
any compensation. However, they do suggest linking knowledge transfer to external
motivation to enhance the process and benefit the organization.
5.3.8 Barriers to Knowledge Transfer
This section discusses the factors that hinder the transfer of knowledge in the
organization. The work environment includes several factors that impede the knowledge
transfer process. Barriers to knowledge transfer were classified into lack of management
support, the general culture of the workplace, and workload. Participants acknowledged
that negative personalities and perceptions in the workplace, such as selfishness and
resistance to sharing knowledge, can have an impeding effect on the transfer of
knowledge, as illustrated in the following statements:
• “A lot – People resist sharing knowledge”, “the culture is unhealthy”
Department A respondent
• “Resistance to share knowledge because knowledge is power”
Department B respondent
• “power knowledge … afraid to lose their job, no trust, ego issues, selfishness”
Department B respondent
• “Selfishness ... Knowledge is power.”
Department B respondent
• “… afraid to lose power, job, and position”
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Department A respondent
• “Afraid to lose position/power”
Department A respondent
These responses indicate that the work environment in both clinical and non-clinical
departments does not fully support knowledge transfer and affects an employee’s
motivation and ability to transfer knowledge. This work environment is a reflection of the
culture of the workplace, which is shaped by the practices and attitudes of the employee’s
manager and co-workers. This section confirmed that the culture of the work
environment is an important factor in the knowledge transfer process. The responses
suggest that the culture of the workplace does not support knowledge transfer. The main
issue appears to be the attitude of peers towards knowledge and knowledge transfer,
where employees see knowledge as power. Knowledge hoarding appears to be an issue in
these departments; this can also be considered as knowledge hiding (Serenko & Bontis,
2016) and this behavior negatively impacts organizational competitiveness (Holten,
Hancok, Persson, Hansen & Hogh, 2016).
It is also worth mentioning that the responses suggest that the respondents see themselves
as knowledge receivers and a number of participants mentioned that “people resist
sharing knowledge.” This can be attributed to the fact that some of the respondents have
limited experience in their current jobs and expect knowledge to be transferred to them.
This coincides with the fact that there are generation and experience gaps, as mentioned
by the respondents in the earlier phase. The perception of knowledge as a source of
power and transferring knowledge as the loss of power appears to be a major impeding
factor in knowledge transfer. This can be attributed to a lack of trust or an unhealthy
work culture. This resistance to transferring knowledge in the work environment exists in
both department A (non-clinical area) and department B (clinical area). It was surprising
that despite the cooperative environment in department B, mentioned by respondents in
the previous sections, there is resistance to transferring knowledge. Can this be attributed
to the generation gap found in the clinical areas?
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Other barriers to knowledge transfer include leadership, management and support for
employee development. Most responses outlined the negative attitude from managers to
knowledge transfer. The following responses suggest that managers do not provide their
employees with the opportunity to transfer knowledge:
• “Leadership is a barrier, it affects organizational culture and knowledge transfer.
They afraid to lose position/Selfishness” [sic]
Department A respondent
• “Management”
Department A respondent
• “Managers”
Department A respondent
The results suggest that management was another major barrier to knowledge transfer.
Managers’ attitudes towards knowledge and its transfer play an important role in the
knowledge transfer process. All the responses related to management being a barrier
came from department A, the non-clinical area. Managers play a major role in fostering a
knowledge transfer environment and creating a climate for knowledge and its transfer.
Management was also mentioned repeatedly by respondents when discussing
organizational culture factors that impact on knowledge transfer. Perhaps the process of
knowledge transfer can be facilitated by managers supporting or motivating their
employees to transfer knowledge in the workplace. However, the managers in this
organization, both the clinical and the non-clinical areas, senior and lower-level
managers, do not facilitate the transfer of knowledge.
Some of the respondents added lack of time as a barrier, due to staff shortages and the
increase in workload, as indicated in the following comments:
• “Workload is too much”
Department B respondent
• “Too busy to transfer knowledge”
Department B respondent
• “Lack of time”
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Department B respondent
• “Distribution of work.”
Department B respondent
The organization appears to be highly customer-oriented, so that employees have no time
to focus on other activities, such as knowledge transfer. The workload was the most
recurring response of participants in department B (clinical jobs) and was obviously seen
as a limitation to transferring knowledge. These findings coincide with the responses
from the questionnaire, which were discussed previously, where workload was also
identified as a barrier. Staff shortage was mentioned as a reason for the lack of time for
knowledge transfer. Another reason that was mentioned by the respondents was the
“distribution” of the work. This issue can be considered a management issue, where
managers lack the basic skills to manage daily operations. Despite the reason for the
workload issue, it can be concluded that the organization’s current focus is solely on
providing health care services, disregarding its employees. Perhaps senior management
and direct managers, as is most apparent in department B, do not see the need for or the
value of transferring knowledge in the organization.
To summarize, the work environment factors that hinder the transfer of knowledge
include: the team environment, management, and the workload. The above results
suggest that workload is perceived as the major barrier to the transfer of knowledge in the
clinical areas and the lack of management support as the main constraint in the non-
clinical areas. The team environment and the perceptions of knowledge and knowledge
transfer seem to be common limitations to knowledge transfer in both the clinical and
non-clinical areas. Despite the nature of the job, it is apparent that the work environment
is the main barrier to knowledge transfer. This also coincides with the results of the
survey that were discussed previously, since in phase one the main barriers to knowledge
transfer were identified as management, the generation gap, and the workload.
5.4 Discussion and Conclusion
This research was influenced by the following research questions:
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1 What are the organizational culture factors that affect the transfer of knowledge in
health care?
2 Which mechanism is most effective when transferring critical organizational
knowledge such as the mission and vision in health care?
3 What are the most significant and least significant knowledge transfer practices in
health care?
This research investigated the organizational culture factors that impact on the transfer of
knowledge in health care. Research data were collected using questionnaires, followed by
semi-structured interviews. The findings identified several factors that influence the
transfer of knowledge and the various knowledge transfer practices that are implemented.
The research confirms that organizational culture does play a role in knowledge transfer
practices in this health care organization. The study represents an advance over existing
studies in that it attempts to emphasize the impeding and enabling role of organizational
culture on the process of knowledge transfer. The findings of this research provide some
indication as to how these various factors impact on the knowledge transfer process.
The results suggest that communication is imperative in any organization. Organizations
need to have a communication plan or structured knowledge transfer procedure to
communicate organizational knowledge to all employees. In this organization, significant
organizational knowledge such as the mission and vision were transferred and
communicated to employees through emails, posters, and regular meetings (internal staff
meetings or organizational town halls). This addresses the second research question,
pertaining to communicating the vision and mission to the rest of the organization. Most
of the respondents seemed to be familiar with the mission and the vision of the
organization and were generally content with the methods utilized to communicate
critical knowledge across the organization.
The individuals’ perception of organizational culture knowledge transfer is considered to
be important. The online questionnaire asked about the degree of importance of a list of
knowledge transfer practices. The outcomes from the questionnaire create a reference to
contextual influences on knowledge transfer that might impact individuals‘ perception to
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transfer knowledge practices in the organization. The result of the questionnaire was
shared with interviewees and asked for their input. All the interviewees have agreed that
communication with the supervisor is an important method to transfer knowledge and
management support is a significant factor in knowledge transfer. This result could be
attributed to the social aspect of the culture or the formal hierarchical structure of the
organization.
The survey results also suggest that employees perceive customers’ or patients’ needs as
a priority; this is considered a significant value that forms the basis of the culture of this
organization. This is a true reflection of what a health care culture should be,
emphasizing delivering quality care to customers or patients. This is expected and should
be undeniably the heart of all health care organizations. In this organization, patient care
is more important than other factors related to employees, the team and the organization,
as indicated in the previous section. This addresses the first research question, pertaining
to the organizational culture that affects knowledge transfer in health care organizations.
To facilitate knowledge transfer within the organization, managers need to consider and
develop a mission and vision strategy that focus on patient and customer care. The
organization’s mission and vision are considered a guide for all organizational activities.
As such, managers need to develop a clear and structured communication strategy to
transfer such critical organizational knowledge across the organization to all employees.
The online questionnaire asked another question in relation to the organizational culture.
The results of the questionnaire were shared with interviewees and asked if they agree
with the results. All the interviewees have agreed that patients or customers are of utmost
significance as it shapes the culture of the organization. This shows a complete consensus
in favor of having a relationship that exists between customer/ patient care and
organizational culture in health care organizations. The participants were also asked if
they agree that organizational culture influences knowledge transfer. About 60% of the
interviewees have agreed that the needs of customers and patients have a significant
impact on organizational culture and 40% have disagreed with that statement and
indicated that patients’ needs have an indirect impact on knowledge transfer. This result
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could be attributed to the fact that in health care organizations, the needs of the patients’
is expected to be the highest priority.
The findings from both the questionnaires and the interviews indicate that there are
various factors that hinder knowledge transfer. Staff shortage, workload, and time
constraints were all perceived as factors that impinge on the transfer of knowledge. Lack
of management support and the generation gap were also identified as barriers to
knowledge transfer. A major impeding factor to knowledge transfer that was identified
during the interview process is the unwillingness to transfer knowledge, as knowledge is
perceived as power and giving away knowledge means giving away power.
Conversely, the most significant driver of knowledge transfer was the motivation to
transfer knowledge or, as referred to by one of the respondents, taking the “initiative,”
which can be due to either internal or external motivation. Employees will be motivated
to transfer knowledge if motivational factors are present to initiate the act of transferring
knowledge. This confirms the findings of the study by Lucas (2006), which suggested
that incentives should be offered to get individuals engaged in the knowledge transfer
process.
Some factors were recognized as both barriers to and drivers of knowledge transfer.
Communication is considered one of these factors. Both the positive and negative sides of
communication were revealed by the respondents. Knowledge transfer resources and the
actual knowledge transfer process were other factors that were considered as both drivers
and barriers.
It was noted that there are more barriers to the knowledge transfer process than drivers in
the organization. The comments provided indicate that there are multiple barriers to
knowledge transfer in the organization. This might explain why 43.21% of the
respondents (as indicated in Table 5.15) were dissatisfied with the knowledge transfer
practices implemented in the organization. Perhaps the other 56.79% of respondents were
unaware of the knowledge transfer practices available and not necessarily satisfied with
the implementation of these practices. The employees might be facing difficulties
accessing available information or transferring available knowledge in the organization.
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Therefore, key issues in the organization might be the accessibility and availability of
knowledge.
The findings in this section address the third research question. The type of knowledge
has not been specified in any of the statements pertaining to the knowledge transfer
practices. Hence, it can be assumed that the respondents were considering both tacit and
explicit knowledge when rating the statements. The most significant knowledge transfer
practice is regular communication with the supervisor. This confirms the significance of
communication for knowledge transfer. However, according to the more experienced
employees, receiving guidance from senior employees is the most important knowledge
transfer practice, while the less experienced employees perceive attending lectures and
courses as more important. Despite the importance of shadowing other employees in
transferring knowledge in departments, this was selected as the least significant
knowledge transfer mechanism amongst the respondents.
Experience was identified as an influential and significant factor when discussing
knowledge transfer. During the knowledge transfer process, the knowledge recipient
(individual, team, or organization) is affected by the experience and knowledge of the
knowledge holder. As such, individuals can learn from the experience of other
individuals who work in the same department, different departments through networking
or work assignments, or other organizations through partnership agreements and outside
consultants. “Learning from the experience of others” can be considered a significant
foundation for effective knowledge transfer practices, which can result in improved
organizational performance by identifying new practices and avoiding prior errors
(Loxton, 2014). Argote, Ingram, Levine and Moreland (2000), in a paper entitled
“Knowledge Transfer in Organizations: Learning from the Experience of Others,”
discussed effective procedures for knowledge transfer and the factors that affect the
process. Based on the above, knowledge transfer mechanisms which embrace the concept
of learning from the experience of others can occur in two ways: intra-organization
(within the organization) through formal or informal interaction, communication, and
networking with other employees within the department or organization, and inter-
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organization (outside the organization) through interactions with external consultants and
suppliers.
To encourage knowledge transfer within an organization and to foster a culture that is
committed to knowledge transfer, these research findings need to be taken into
consideration. Managers and organizational leaders are required to properly understand
the organizational culture and utilize this knowledge to develop a comprehensive
knowledge transfer model and strategy to communicate all the significant organizational
changes and knowledge to all employees.
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Chapter 6: Discussion and Conclusion
Organizational Culture and Knowledge Transfer in Health Care: What Next?
6.1 Overview of the Research
This research was designed to identify the organizational culture factors that impact on
the transfer of knowledge in health care. This study is unique in that two critical and
much researched concepts (knowledge transfer and organizational culture) are explored
in a context that combines two complex settings (health care and Saudi Arabia). The
literature suggests that knowledge transfer is influenced by the organizational culture in
organizations (Lang, 2001). Yet, previous studies do not specify the type of organization
or the country in which the present research was conducted. Most studies have been
conducted in Western countries, while conducting research in the Middle East is
accompanied by various challenges, such as obtaining permission (Lages, Pfajfar &
Shoham, 2015). This research study accepted the challenge and focused on studying the
impact of organizational culture factors on knowledge transfer in health care in Saudi
Arabia.
The main objective of this study was to identify the organizational culture factors that
impact on knowledge transfer in a health care organization. This was achieved by
implementing quantitative and qualitative research methods in a health care organization
in Saudi Arabia. This study also identified the most effective knowledge transfer
practices in health care organizations.
Chapter 1 of this research study presented the study aims and objectives and outlined the
research questions that guided this study. The research background, purpose, and
significance were all presented in the first chapter as well. This chapter concluded with
the overall structure of the study.
Chapters 2 and 3 comprised an extensive review of the existing literature on the two
major themes of this research, namely knowledge transfer and organizational culture.
Studies on the topic of knowledge transfer were presented in Chapter 2, while the
organizational culture literature was presented in Chapter 3. Chapter 2 focused on the
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concept of knowledge transfer: the chapter outlined the existing research on knowledge
transfer in organizations and explored the various dimensions of knowledge transfer in
organizations. Chapter 3 focused on organizational culture and investigated its influence
on knowledge transfer. It also presented the unique cultural characteristics of Saudi
Arabia (social, religious, and economic) and how this influence the culture of the
organization.
Chapter 4 discussed the research methodology and all the approaches utilized in the study
in detail. This chapter presented the research strategy, the data collection methods, and
the data analysis process in light of the research questions.
In Chapter 5, the research results and collected data from the questionnaires and
interviews were analyzed. The results were discussed in detail and linked to the research
study’s primary objectives to answer the research questions. Key themes and
recommendations were also identified and presented in this chapter.
This final chapter, Chapter 6, outlines all the conclusions and closing remarks based on
the previous chapters. In addition, the research questions are restated and the primary
debates regarding the research are discussed. The chapter concludes with the practical
implications and a few recommendations for future research.
6.2 Introduction
This final chapter combines the discussions and findings extrapolated throughout the
research and presents them in light of the research questions. This chapter is organized
around the main research questions and each section will explain how the results answer
those questions. Following this, there will be a discussion of the main research
contributions and practical implications. Finally, recommendations for further research
will be presented.
The focus of this research study was to identify the organizational culture factors that
impact on the transfer of knowledge. An extensive literature review suggested that nearly
all existing research pertaining to knowledge in organizations has focused on the transfer
of knowledge. This research study utilized both quantitative and qualitative
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methodologies to identify the organizational culture factors that impact on knowledge
transfer practices in health care organizations. What sets this study apart from the rest is
its focus on the health care sector in Saudi Arabia. While other studies on knowledge
transfer have investigated the relationship between knowledge transfer and organizational
culture, most of these studies have been conducted in developed countries. As mentioned
earlier, this research is unique, as it explores knowledge transfer in two contexts (health
care and Saudi Arabia) which have not been considered together in one study before.
Accordingly, the findings of this research study offer original contributions to the
organizational development, human resources, and management literature.
The first part of this chapter is divided into three sections, guided by the three research
questions. These three sections discuss the main research findings and conclusions in
light of the research questions.
1. What are the organizational culture factors that affect the transfer of
knowledge in health care organizations?
This study identifies the key cultural values and beliefs that define an organization. The
research findings conclude that the main organizational culture factors that affect the
knowledge transfer process in health care are meeting the patients/customers’ needs and
considering this the responsibility of each employee. These results suggest that the
organization builds its culture on meeting the needs of the customers or patients. This
corresponds with the research conducted by Assouad and Overby (2016), which has
suggested that culture plays a significant role in customer satisfaction. This can be
attributed to the fact that patient care is considered the central component of any health
care organization’s business strategy, mission, and vision. Mead and Bower (2000) have
concurred that health care organizations embrace patient-centeredness as an
organizational value and Kukkurainen, Suominen, Rankinen, Harkonen, and Kuokkanen
(2012) have agreed that health care organizations’ vision should emphasize meeting the
patient’s needs. This research study confirms that health care organizations shape their
culture substantially on customer service and patient care. In addition, organizations
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should consider the customers/patients’ needs when developing activities such as
knowledge transfer.
Employees in an organization are part of a culture that embraces the same values and
principles and adopts the organization’s mission, vision, and strategic priorities. Hofstede
(2001) has stated that organizational cultures are characterized as socially constructed
and “values” are at the center of organizational culture. This research study explained that
the patient/customer is considered as the “value” and is at the core of the organization’s
culture. This appears to be the same value embedded in Sony Ericsson’s organizational
culture, as suggested by Career (2008) and Ahmed and Pang (2009). Hofstede (1991) has
also explained that values can be expressed in actions. In the context of this research, the
“value,” that is the patient/customer, is expressed through the “action” of knowledge
transfer. Denison and Mishra’s culture model (1995) includes four organizational culture
traits, namely adaptability, consistency, mission, and involvement. In a study by
Gillespie, Denison, Haaland, and Smerek (2008), the highest scoring organizational
culture trait was “adaptability,” which is in line with the findings of this research.
However, other studies in health care settings, such as the research by Hamidi et al.
(2017), have scored high on the “mission” trait. This suggests that each health care
organization has its own unique organizational culture, which depends on multiple
internal and external factors, and which has various effects on the organization.
Other key themes were identified by analyzing the research participants’ comments that
were extracted from the questionnaire and the interview processes. The following are
some of the factors that influence and impede the knowledge transfer process:
• Having intrinsic motivation to transfer knowledge was identified as a significant
factor that has a positive effect on knowledge transfer. Internal motivation is
driven internally by the individual’s own self to accomplish a personal goal or
self-satisfaction (Cruz et al., 2009). According to some of the respondents,
intrinsic motivation enables the process of knowledge transfer in the organization,
which agrees with the research finding by Cruz et al. (2009). However, this does
not exclude the importance of external incentives and other extrinsic motivation
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factors for knowledge transfer, such as linking it to the performance cycle and
other reward systems.
• Knowledge transfer usually requires an effective vehicle and “fertile” context to
happen, as suggested by Szulanski (1996, p. 32), where the vehicle is the
workplace environment. Knowledge transfer can occur through formal or
informal communication between individuals and between managers and
employees. The individual perceptions of knowledge in the workplace were
considered a barrier to knowledge transfer, as identified by the participants during
the interviews. Individual attitudes toward knowledge include the willingness to
share or transfer knowledge. This is considered to be a key factor in creating an
atmosphere that promotes knowledge transfer in the workplace. The collected
responses strongly indicate that the individuals in the organization under research
seem to refrain from transferring knowledge in the workplace. Apparently, the
resistance to transferring knowledge is out of fear of losing the power of status or
position. It is hypothesized that “knowledge is power and job security and
therefore needs to be hoarded” (Rance, 2011, p. 242). Knowledge is perceived to
be a source of power and individuals demonstrate expertise by holding knowledge
(Pandey & Dutta, 2013). Accordingly, some employees’ attitudes towards
knowledge (knowledge hoarding) and its transfer appear to be a barrier to
knowledge transfer.
• The availability of knowledge transfer resources in the organization was
considered a positive influencing factor that encouraged employees to utilize the
resources available and participate in knowledge transfer activities. This practice
encouraged autonomy and allowed employees to be accountable and responsible
for the transfer of their own knowledge. Consequently, the lack of visibility of the
knowledge resources had a negative impact on the knowledge transfer process.
The lack of familiarity with the knowledge resources available within the
organization hindered the knowledge transfer process.
• There are multiple barriers to knowledge transfer, as indicated in various research
studies (Davenport & Prusak, 2000). The results indicate that staff shortage and
workload hinder knowledge transfer opportunities. The generation gap between
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employees was considered a barrier to knowledge transfer as well. A workplace
environment that enables communication and social interaction among employees
is considered an excellent context for knowledge transfer. The generation gap and
staff shortage affect the overall work environment in an organization, which has
an adverse effect on the transfer of knowledge. While many studies have
investigated the transfer of knowledge between different generations of
employees, fewer studies have explored the knowledge transfer process and the
generation gap in the workplace in various contexts, including health care. Brčić
and Mihelič (2015) have stated that generational differences might impede the
effectiveness of knowledge sharing and organizations need to design formal
knowledge-sharing mechanisms that consider all the generations. This research
concurs and suggests that generational differences negatively impact the transfer
of knowledge in the organization.
• Another identified factor that impacts knowledge transfer is management. This
factor refers to managers’ support for the transfer of knowledge. Managers can
support the knowledge transfer process by providing proper resources to transfer
knowledge in the organization (Rhodes, Hung, Lok, Lien, & Wu, 2008). The
findings from both the questionnaires and the interviews indicate that a lack of
management support has a negative impact on the transfer of knowledge. The lack
of transparency and lack of management support resulted in communication
issues, which negatively impacted on the transfer of knowledge. The lack of
openness in communication between managers and employees results in distrust
and insecurity (Denton, 2011). Management support is an important contextual
factor to transfer knowledge, as indicated by the respondents during the
interviews. Management support refers to encouraging communication and
interaction between employees to ensure that knowledge is effectively transferred.
This was identified as a significant motivation factor to transfer knowledge in the
organization. It also relates to providing extrinsic incentives to motivate
employees to participate in knowledge transfer initiatives.
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2. What are the most significant and least significant knowledge transfer practices
in health care?
To answer this research question, the study considered a wide range of knowledge
transfer practices implemented in the health care organization, to identify the most
significant and least significant practices. Whilst the respondents identified lack of
management support as a factor that hinders the knowledge transfer process, the results of
this question identified that regular communication with the supervisor is the most
significant knowledge transfer method and shadowing other employees is the least
significant knowledge transfer method.
According to the previous finding, communication was considered as both a driver and a
barrier to the knowledge transfer process. Effective communication allows for the proper
transfer of knowledge, and the lack of communication can jeopardize the transfer of
knowledge. Both results suggest that communication is of the utmost importance to the
employees in this health care organization.
As explained earlier, one of the main factors that can influence knowledge transfer is
management support, by which knowledge transfer is encouraged, both informally and
formally, within health care organizations. This contradicts the findings of a study by
Hung, Huang, and Chou (2015) which explored the factors that influence physicians’
knowledge transfer, and which stated that there was no relationship between support by
top management and knowledge transmission success. Another study by Girdauskiene
and Savaneviciene (2012) concluded that the direct leadership effect on the transfer of
knowledge is weak. Nonetheless, the findings of this research study suggest that there is a
relationship between management and knowledge transfer in health care, where managers
are responsible for encouraging employees to transfer knowledge and implementing
various knowledge transfer practices, such as communities of practice and online forums,
across the organization. According to the questionnaire results, the most significant form
of knowledge transfer is communicating with the manager. This can include regular
formal meetings and informal discussions. Managers are expected not only to
communicate organizational knowledge but are also required to spend time listening to
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employees to understand their issues and concerns, which can establish a level of trust
between management and employees.
Communication with the supervisor or manager helps create an environment where the
transfer of knowledge is encouraged. Regular communication with the manager increases
the level of trust (Husain, 2013). Renzl (2008) has explained that trust in management
affects the extent of knowledge sharing among levels. Apparently, in this health care
organization, management visibility is a must and essential to the employees. Employees
trust that management will consistently communicate organizational changes or updates.
No research study exists that explores the relationship between communication with
managers and knowledge transfer in organizations. However, this research study suggests
that communication with supervisors is significant and beneficial for transferring
knowledge. The study also suggests that the work atmosphere and work culture in a
clinical environment is more cooperative and accommodative than in a non-clinical
environment, where non-clinical environments were described as “uncooperative,” “no
teamwork exists” and “competitive.” This can be attributed to the general nature of the
job roles in the clinical environment, which has a direct or indirect relation to patients and
health care.
The least significant knowledge transfer method, as indicated by the respondents, is
shadowing other employees. In this study, following or shadowing other employees is
considered least significant in the knowledge transfer process. The argument is that
formal mentoring in health care, such as observership programs, might have a negative
effect on the knowledge receivers. This finding is supported by a study by Brčiz and
Mihelič (2015), which explained that less knowledge is transferred through mentoring.
One explanation is that shadowing programs constrains employees and denies them the
freedom of choosing the knowledge to be transferred. Another explanation is the
existence of a generation gap: a study by Mohr et al. (2012) confirms that “mentorship,
which has been the cornerstone of academic medicine, is one forum where generational
differences readily surface” (p. 6).
149
Apparently, in this health care organization, informal social interaction is preferred over
formal knowledge transfer programs; knowledge can easily be transferred in the context
of communication networks. This finding confirms the conclusion by Oborn, Barrett, and
Racko (2010) which suggests that physicians can transfer their clinical knowledge by
means of informal interaction and communication. However, these findings do not
necessarily confirm the network structure and dynamics of employees in health care
organizations. This also does not confirm what is the preferred mechanism for
transferring clinical knowledge amongst health care professionals. Further research is
required on this topic of transferring clinical knowledge in health care.
The study found that the experience of employees was one of the main factors that
influence the choice of knowledge transfer mechanism. This supports Argote and
Ingram’s (2000) knowledge transfer definition that links knowledge to experience. In an
interconnected environment, employees can benefit from the rich experience and
knowledge repository available in the organization that combines the experience and
knowledge of all employees. Hung, Huang, and Chou (2015) have confirmed that
experience and incentives are factors that affect the success of knowledge transmission.
The research respondents also indicated that, despite the wide range of knowledge
transfer practices available in the organization, some methods are under-utilized. This
includes the exchange of knowledge with other organizations and external consultants.
Interaction with outside consultants from other organizations is an important form of
knowledge transfer. This study found that employees would like to take advantage of all
the knowledge transfer opportunities available, specifically for clinical knowledge
transfer.
3. Which knowledge transfer mechanisms are most effective when transferring
critical knowledge (mission and vision) within organizations?
The research respondents indicated that the organization’s mission and vision were
familiar and clear, which was a true reflection of the culture of the organization that is
based on meeting the needs of the patients/customers. Senge (2006) has stated that having
a shared vision is considered a motivating value that influences knowledge transfer in
150
health care. The organization’s mission and vision must be in alignment with the
employees’ shared values (Piper, 2005), which form the culture of the organization.
The majority of respondents reported that amongst the most effective communication
methods were emails, meetings, and posters, which include a combination of written and
oral communication forms. Written communication includes posters distributed all over
the organization and communication emails sent out to all employees. Oral
communication includes meetings with peers, managers, and townhall meetings with
senior management. This finding coincides with the results of the previous research
question, which indicated that regular communication with the supervisor is the most
significant knowledge transfer practice in the health care organization. Bresman,
Birkinshaw, and Nobel (1999) have confirmed that communication in organizations is a
requirement and important to avoid any misinformation.
6.3 Practical Implications for Organizations
This research has several practical implications for organizations. This research
contributes to the general understanding of the culture of Saudi Arabia and Saudi
organizations; this can help identify the impact of organizational culture on achieving
organizational objectives and strategies in Saudi Arabia. Managers in organizations
should consider the research findings when developing business strategies which assist
organizations in gaining an advantage compared to global competitors.
One of the research implications concerns organizational culture in health care settings.
The study confirms that organizational culture does affect the knowledge transfer process
in health care. Accordingly, health care organizations need to have a strong culture to
retain their competitive advantage. This can be achieved by exploring and understanding
the organizational culture factors and their implications for various organizational
activities such as knowledge transfer.
Knowledge transfer is important for the success of organizations (Thomas & Pretat,
2009) and health care is no exception. Therefore, senior management should support
knowledge transfer practices within the organization. This study confirms that
151
communication is a significant factor in transferring knowledge in health care.
Accordingly, senior management should develop formal, structured, and regular
communication strategies that transfer critical knowledge to all employees across the
organization. The study also suggests that some of the knowledge transfer resources are
either inaccessible or inadequately utilized. Management should facilitate access to the
knowledge transfer resources to all employees and encourage the utilization of the
resources available to transfer knowledge.
Meeting the patients’ needs was identified as the most significant organizational culture
dimension, which strongly influences knowledge transfer in health care organizations.
Having a patient-focused work environment drives the attention of employees towards
aligning their goals to the organization’s mission, vision, and strategic priorities, which
are expected to focus on delivering high-quality care. To achieve this goal, management
should engage employees in activities that concern the organization and encourage
employees to participate in health care initiatives such as knowledge transfer. This not
only increases employee engagement, but also results in employee commitment and
encourages employees to transfer knowledge in the organization.
The role of managers is significant and undeniable in the health care organization, as
concluded in this research. In organizations, employees need regular communication
from their management, since communication with the manager was considered the most
significant knowledge transfer practice. Management plays a vital role in transferring
knowledge in health care organizations. This finding should be utilized by senior
management to encourage employees during townhall meetings to participate in
knowledge transfer initiatives in the organization, to foster the effective transfer of
critical and clinical knowledge to achieve organizational success and operational
excellence, which is linked to patient care and customer satisfaction.
This study concludes that the culture of the work environment affects the knowledge
transfer process. The research has managed to shed light on the concept of organizational
culture and its impact on the transfer of knowledge and its relation to health care.
Hopefully this research study will help other researchers understand the various
152
contextual factors that impact on the knowledge transfer process in health care. In
conclusion, the concept of knowledge transfer in the organization is a crucial and widely
research process; however, its relation to organizational culture in various contexts still
needs exploring. Only when the context of knowledge transfer is better understood, can
we find better approaches to knowledge transfer.
6.4 Research Contributions
The main objective of this research is to explore the organizational culture factors that
impact on the transfer of knowledge in the context of health care, in Saudi Arabia. This
research involved a case study of a health care organization in Saudi Arabia. This is the
first study that encompasses studying organizational culture and knowledge transfer in a
health care setting in Saudi Arabia. This research explores the impact of organizational
culture factors on the knowledge transfer process in a critical sector such as health care,
in a culture-oriented environment such as Saudi Arabia. Therefore, the research
contributes to the understanding of two main concepts, knowledge transfer and
organizational culture, and provides an overview of knowledge transfer in two settings,
health care and Saudi Arabia.
The research involved a case study of a national health care organization, which is bound
by the culture of Saudi Arabia. The study revealed that health care organizations in Saudi
Arabia need to engage more in knowledge transfer programs if they wish to retain
organizational and professional knowledge. Senior management are encouraged to
motivate the employees to transfer their knowledge to create a knowledge transfer culture
in the organization. Aligning the organization’s business objectives with organizational
initiatives such as knowledge transfer will help in creating a strong organizational culture
that focuses on employee development, as well as patient care. This might help
organizations to retain knowledge and top talent. Further research is required in the area
of management and knowledge transfer.
There is a lack of theoretical frameworks on the topic of knowledge transfer in health
care. This study contributes to the understanding of knowledge transfer in health care
organizations. This research assists in bridging the gap in the knowledge transfer
153
literature by identifying the most significant practices and mechanisms for transferring
knowledge. There is a lack of theoretical frameworks in the literature to explain
substantial concepts in a health care context. This research adds to the understanding of
knowledge transfer in health care by identifying the organizational culture factors and
other factors that impact on the transfer of knowledge in health care. Therefore, this
research contributes to the knowledge of the cultural value in health care organizations as
well.
This research compared the culture and knowledge transfer practices implemented in
both clinical and non-clinical environments. This provided an opportunity to explore the
organizational culture differences between clinical and non-clinical work cultures and
their impact on knowledge transfer. This adds to the current understanding of individual
and contextual factors for knowledge transfer, as these relate to clinical or health care
settings. The difference between clinical and non-clinical organizational subcultures is an
area that is worth exploring.
6.5 Limitations of the Research
Although this study provided important insights on the topic of organizational culture and
knowledge transfer, it did have a number of limitations that need to be addressed. These
limitations were discussed in detail in previous chapters. This section summarizes and
highlights the research limitations and challenges.
One of the main limitations concern the research methodology. In quantitative research,
the sample group was a major limitation, as some of those who completed the research
questionnaire were not part of the selected research sample group, which might have
affected the research findings. In addition, all the respondents worked in the same
organization in which the researcher worked, so that a good relationship and rapport had
already been established between the research respondents and the researcher. This might
be considered an advantage, but there is also a risk of bias. Despite the efforts the
researcher made to remain ethical and sustain objectivity during the research, the risk of
bias remains a limitation. Objectivity was an issue since the researcher is familiar with
the Saudi Arabian culture. Being familiar with the Saudi social customs might be
154
considered an advantage in this research; however, being too familiar with the traditions
and customs would again jeopardize the objectivity of this research. To resolve this issue,
the researcher discussed the research results and observations with the research advisor,
who is less familiar with the Saudi context.
In this study, a second data collection approach was added to the research design.
Including a qualitative data collection approach proved to be challenging; however, it did
increase the strength of the research design. The research utilized a semi-structured
interview approach as a data collection approach, which itself was challenging. The data
analysis was also challenging, as it included coding and identifying common themes.
Other research limitations include the period during which the research was conducted.
The study took place in a period when organizational changes were taking place. The
organization’s management kept on changing, which resulted in accessibility issues. With
the constant changes in policies, rules, and management, significant research resources
such as SPSS were unattainable and research support was not fully secured, so that the
situation was unpredictable and the future ambiguous. Therefore, MS Excel was utilized
for analyzing the data, as opposed to SPSS.
Despite the limitations of this research, the study has succeeded in raising awareness and
drawing attention to the significance of researching knowledge transfer and exploring the
process in different locations, especially Saudi Arabia, and various contexts, such as
health care. In addition, I hope that this research managed to change the perception
towards conducting research in Saudi Arabia and health care and to inspire future
research to expand beyond any research limitations. Researchers are called to adopt a
broader view on organizational culture to investigate different contexts, which can lead to
alternative research results and conclusions (Johns, 2006), such as Saudi Arabia
(Deresky, 2014). This case study research is the first of its kind, as it examines
organizational culture and knowledge transfer in a health care organization in a
developing economy (Saudi Arabia). Existing studies on organizational culture factors
have predominantly been conducted in organizations based in developed countries.
155
6.6 Recommendations for Future Research
The research findings and conclusions have led to further questions that need answering
and to other areas of research that require additional investigation. Further studies are
necessary to gain a better and more detailed understanding of “how” employees perceive
their knowledge transfer experience in the context of health care.
Future research should be directed at addressing the limitations of the research
methodology and improving the structure of research design. The same research design
or an improved design can be utilized in future research studies, which would consider
different sectors other than health care or other geographical locations as a research
setting. Future studies can also examine the significance and effectiveness of knowledge
transfer mechanisms for a specific group, such as female managers or different
generations. The knowledge transfer process can be investigated from the perspective of
both the knowledge provider and the recipient. Researchers can also consider comparing
the transfer of different knowledge types (explicit and tacit) or exploring the difference
between the various concepts of knowledge transfer, knowledge sharing, and knowledge
exchange in organizations. They could also study the difference between individual,
group, and organizational knowledge transfer and whether variations exist regarding
employee preferences. Another area of interest would be to study the effectiveness of the
various types of knowledge transfer in virtual online environments.
Future research might also decide to focus on exploring the national or organizational
culture factors that affect the knowledge transfer process. It would be interesting to
empirically investigate and compare the process of knowledge transfer in organizations
situated in developing and developed countries that have significant cultural differences.
Such studies could conclude with practical recommendations on how to overcome
cultural gaps when transferring knowledge between individuals and groups, or between
organizations across international borders. Such studies would be particularly beneficial
and would have practical implications for health organizations.
For organizations to remain competitive, they need to be able to retain their knowledge
source. Understanding the organizational culture and the shifting demographics in the
156
workplace environment can assist in managing knowledge through organizational
initiatives such as knowledge transfer practices. There is a need to conduct more studies
on the generational gap and its impact on various organizational activities and cultural
attributes. Each generation has its own knowledge transfer practice preference.
Researchers can provide more empirical research and recommendations to managers on
how to manage the existing generation gap in the workplace and suggest various
interventions to address issues that might emerge in terms of organizational culture.
Future studies can focus on the outcomes of transferring knowledge on the employees,
such as a change in attitudes or the correlation between knowledge and job performance.
Future research can also explore the motivation to transfer knowledge in relation to
performance, both at individual and organizational levels. In addition, developing a
structured knowledge transfer plan can maximize the outcomes of transferring knowledge
and result in improved performance.
Most existing organizational culture and knowledge transfer researchers adopt either a
quantitative or a qualitative approach. This study incorporated both qualitative and
quantitative research approaches to utilize the strengths of both approaches. In addition,
following a case study approach, this research adds to the understanding of organizational
culture and knowledge transfer in a health care context, which is usually overlooked in
other organizational studies. In conclusion, investing time and research in developing our
understanding of the knowledge transfer context will result in a better understanding of
the knowledge transfer process and help to find effective and efficient approaches to
make knowledge more transferrable.
157
References
Abunadi, I. (2012). Influence of Culture on e-Government Acceptance in Saudi Arabia,
in School of Information and Communication Technology, Griffith University:
Brisbane, Australia.
Acar, A., & Acar, P. (2012). The Effects of Organizational Culture and Innovativeness on
Business Performance in Healthcare Industry. Procedia-Social and Behavioral
Sciences, 58, 683-692.
Abd Rahman, N., & Shoid, M. (2017). Key Success Factors that Affecting Knowledge
Transfer among Public Organization Employees: A Conceptual Framework,
International Journal of Academic Research in Progressive Education and
Development, 6(3), 238-246.
Addae, D., & Quan-Baffor, K. (2015). The Place of Mixed Methods Research in The
Field of Adult Education: Design Options, Prospects and Challenges. International
Journal of Education and Research, 3, 151-162.
Ahmed, A, & Pang, Z. (2009). Corporate Culture in An International Joint Venture: A
case study of Sony Ericsson. Retrieved from http://www.diva-
portal.org/smash/get/diva2%3A224194/FULLTEXT01.pdf
Ahmed, S. (2012). Impact Of Organizational Culture On Performance Management
Practices In Pakistan. Business Intelligence Journal, 5(1), 50-55.
Akinci, C. & Saunders, M. (2015). Using Questionnaire Surveys For Within-
Organisation HRD Research. Retrieved from:
https://www.academia.edu/23139410/Using_questionnaire_surveys_to_ga
ther_data_for_within_organisation_HRD_research
Al-Alawi, A., Al-Marzooqi, N., & Mohammed, Y. (2007). Organizational culture and
knowledge sharing: critical success factors. Journal of Knowledge Management,
11(2), 22-42.
158
Alamri, A., Cristea, A. & Al-Zaidi, M. (2014). Saudi Arabian Cultural Factors And
Personalised Elearning. Paper presented at the 6th International Conference on
Education and New Learning Technologies, Barcelona, Spain.
Al-Gahtani, S., Hubona, G., & Wang, J. (2007). Information Technology (IT) in Saudi
Arabia: Culture and the acceptance and use of IT. Information & Management, 44,
681–691.
Alkahtani, H., Dawson, R. & Lock, R. (2013). The Impact Of Culture On Saudi Arabian
Information Systems Security. Retrieved from
https://core.ac.uk/download/pdf/18543368.pdf.
Alavi, M., & Leidner, D. (2001). Review: Knowledge Management and Knowledge
Management Systems: Conceptual Foundations and Research Issues. MIS
Quarterly, 25(1), 107-136.
Aldhobaib, M. (2017). The Relationship Between Organisational Culture and Individual
Behaviour in Saudi Arabia. Retrieved from
https://orca.cf.ac.uk/107352/1/2017AldhobaibA%20phd.pdf
Algumzi, A. (2017). The Impact Of Islamic Culture On Business Ethics: Saudi Arabia
And The Practice Of Wasta. Retrieved from
http://eprints.lancs.ac.uk/124023/1/The_Impact_of_Islamic_Culture_on_Business_
Ethics._Clean_copy.pdf
Al-Hanawi, M. , Khan, S. & Al-Borie, H. (2019). Healthcare Human Resource
Development In Saudi Arabia: Emerging Challenges And Opportunities—A
Critical Review. Retrieved from
https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-019-
0112-4.
Aljawi, M. (2009). Impact of Cultural Variations on Knowledge Transfer in International
Joint Ventures – The UAE Example. Retrieved from
https://bspace.buid.ac.ae/bitstream/1234/240/1/60059.pdf
159
Alkhaldi, M., & Olaimat, M. (2006). Knowledge Conversion and Transfer: A
Mathematical Interpretation. The Journal of Information, Knowledge and
Management, 1,137-149.
Almalki M., FitzGerald, G., & Clark, M. (2011). Health care system in Saudi Arabia: an
overview. East Mediterr Health J., 7(10), 784–9.
Alony, I., Jones M., & Whymark, G. (2007). Sharing Tacit Knowledge: A Case Study in
The Australian Film Industry. Informing Science: The International Journal of an
Emerging Transdiscipline, 10, 41-59.
Alvesson, M 2004, Knowledge Work and Knowledge-Intensive Firms. Oxford University
Press, US.
Amaratunga, D., Baldry, D. Sarshar, M., & Newton, R. (2002) Quantitative and
Qualitative Research in the Built Environment: Application of Mixed Research
Approach, Journal of Work Study, 51(1), 17-3.
Ansah, M. & Louw, L. (2019). The Influence Of National Culture On Organizational
Culture Of Multinational Companies. Cogent Social Sciences, 5(1), doi:
10.1080/23311886.2019.1623648
Ansell, C. (2007). Fostering Innovation and Collaboration. Medical device technology,
18(1), 52.
Argote, L. & Ingram, P. (2000). Knowledge Transfer: A Basis for Competitive
Advantage in Firms. Organizational Behavior and Human Decision Processes,
82(1), 150-169.
Argote, L., Ingram, P., Levine, J., & Moreland, R. (2000). Knowledge Transfer in
Organizations: Learning from The Experience of Others. Organizational Behavior
and Human Decision Processes, 82, 1–8.
Armstrong, M. (2001). Human Resource Management: Strategy and Action. London:
Korgan Publishing.
160
Arntzen-Bechina, A. & Leguy, C. (2007). An Insight into Knowledge Flow in
Biomedical Engineering Science, The Electronic Journal of Knowledge
Management, (5)2,153 – 160.
Arsenault, P. (2004). Validating Generational Differences: A Legitimate Diversity And
Leadership Issue. Leadership and Organization Development Journal, 12(2), 124–
141.
Assouad, A., & Overby, J. (2016). The Impact of Culture on Customer Expectations,
Journal of Management Policy and Practice, 17(2), 19-32.
Auerbach, C. & Silverstein, L. (2003). Qualitative Data An Introduction to Coding and
Analysis. New York University, New York.
Baker, T. (1994). Doing Social Research (2nd ed.). New York: McGraw-Hill Inc.
Baum, J. & Ingram, P. (1998). Survival Enhancing Learning in The Manhattan Hotel
Industry, 1898-1980. Management Science, 44, 996-1016.
Benito-Bilbao, J., Sanchez-Fuente, F., & Otegi-Olaso, J. (2015). Mapping the Connection
between Knowledge Transfer and Firm Competitiveness: An Empirical Research
in the Basque Country. Journal of Technology Management & Innovation, 10(4),
45–56.
Berggren, E. & Bernshteyn, R. (2007) Organizational Transparency Drives Company
Performance. J. Manage. Dev. 26 (5), 411–417.
Berkwits, M., & Inui, T. (1998). Making Use Of Qualitative Research Techniques.
Journal of General Internal Medicine, 13, 195-199.
Beugelsdijk S, & Welzel C. (2018). Dimensions and Dynamics of National Culture:
Synthesizing Hofstede With Inglehart, J Cross‐Cultural Psychol, 49(10), pp.1469‐
1505.
161
Bhatt, G. (2001). Knowledge Management in Organizations: Examining the Interaction
Between Technologies, Techniques, And People. Journal of Knowledge
Management, 5(1), 68-75.
Bielefied, W. (2006). Quantitative Research for Non-Profit Management. Non-profit
Management & Leadership, 169, 395-409.
Bingol, D., Sener I., & Cevic E. (2013). The Effect of Organizational Culture on
Organizational Image and Identity: Evidence from a Pharmaceutical Company,
Procedia – Social and Behavioral Sciences, 99, 222-229.
Bishop, D., Felstead, A., Fuller, A., Jewson, N., Yeadon-Lee, T., & Unwin, L. (2006).
Connecting Culture and Learning in Organisations: A Review of Current Themes:
Learning as Work Research Paper, No. 5 June 2006. Cardiff University.
Bisin, A. & Thierry, V. (2005). Cultural Transmission. The New Palgrave Dictionary of
Economics. New York: Palgrave Macmillan.
Bock, G., Zmund, R., & Kim, Y. (2005). Behavioural Intention Formation in Knowledge
Sharing: Examining the Roles of Extrinsic Motivators, Social Psychological
Forces and Organizational Climate, MIS Quarterly: Management Information
Systems, 29(1), 87-111.
Bogdanowicz, M. (2014), Organizational Culture as A Source of Competitive Advantage
– Case Study of a Telecommunication Company in Poland. International Journal
of Contemporary Management, 13(3), 53-66.
Boisnier, A. & Chatman, J. (2002). The Role Of Subcultures In Agile Organizations.
Retrieved from:
https://www.researchgate.net/publication/265206215_The_Role_of_Subcultures_i
n_Agile_Organizations
Borrego, M., Douglas, E. & Amelink, C. (2009). Quantitative, Qualitative, And Mixed
Research Methods In Engineering Education. Journal of Engineering Education,
98(1), 53–66.
162
Bou‐Llusar,J. & Segarra‐Ciprés, M. (2006).Strategic Knowledge Transfer And Its
Implications For Competitive Advantage: An Integrative Conceptual
Framework. Journal of Knowledge Management, 10(4), 100-112.
Brcic, Z. & Mihelic, K. (2015). Knowledge Sharing Between Different Generations of
Employees: An Example from Slovenia. Ekonomska Istrazivanja, 28(1), 853-867.
Bresman, H., Birkinshaw, J., & Nobel, R. (1999). Knowledge transfer in international
acquisitions. Journal of International Business Studies, 30(3), 439-462.
Bryman, A. (2004). Social Research Methods (2nd ed.). New York: Oxford University
Press.
Bryman, A. (2008). Social Research Methods (3rd ed.). New York: Oxford University
Press.
Buchanan, D. & Huczynski, A. (2004), Organisational Behaviour (5th ed.). London: FT
Prentice.
Chan, Y., & Ford, P. (2003). Knowledge Sharing in A Multi-Cultural Setting: A Case
Study. Knowledge Management Research and Practice, 1, 11-27.
Calman, N., Kitson, K., & Hauser, D. (2007). Using Information Technology to Improve
Health Quality and Safety in Community Health Centers. Progress in Community
Health Partnerships: Research, Education, and Action, 1(1), 83-88.
Careers. (2008). Careers – The Sony Ericsson Story. Retrieved from
http://www.sonyericsson.com/cws/corporate/company/jobsandcareers/thesonyerics
sonstory.
Carlile, P. (2004). Transferring, Translating and Transforming: An Integrative
Framework for Managing Knowledge across Boundaries, Organization Science,
15(5), 555-568.
163
Carr, L. (1994). The Strengths And Weaknesses Of Quantitative And Qualitative
Research: What Method For Nursing? Journal of Advanced Nursing 20 (4), 716-
721
Chen, L. & Mohamed, S., (2010). The strategic importance of tacit knowledge
management activities in construction. Construction Innovation, 10(2), 138-163.
Chen, J. & McQueen, R. (2010). Knowledge Transfer Processes for Different Experience
Levels of Knowledge Recipients at an Offshore Technical Support Center.
Information Technology & People, 23(1),.54-79.
Chen, J., Sun, P. & McQueen, R. (2010). The Impact of National Cultures on Structured
Knowledge Transfer. Journal of Knowledge Management, 14(2), 228-242.
Chilton, M.& Bloodgood, J. (2007). The Dimensions of Tacit & Explicit Knowledge: A
Description and Measure. In the Proceedings of the 40th Annual Hawaii
International Conference on System Sciences. Doi:10.1109/HICSS.2007.524.
Clarke, A. (2006). Qualitative Interviewing: Encountering Ethical Issues And Challenges,
Nurse Researcher. 13(4), 19-29.
CLMS (2004) Doctorate in Social Sciences (HRD), Module 2.
Conklin J. & Stolee, P. (2008) A Model for Evaluating Knowledge Exchange in A
Network Context, The Canadian Journal of Nursing Research, 40(2), 116–124.
Cooke, R. A., & Rousseau, D. (1988). Behavioral Norms And Expectations: A
Quantitative Approach To The Assessment Of Organizational Culture. Group and
Organization Studies, 13, 245–273.
Cranefield, J. & Yong, P. (2005). Organisational Factors Affecting Inter-Organisational
Knowledge Transfer In The New Zealand State Sector - A Case Study. The
Electronic Journal for Virtual Organizations and Networks. 7.
164
Creswell, J., Clark, V., Gutmann, M. & Hanson, W. (2003). Advanced Mixed Methods
Research Designs. In Handbook Of Mixed Methods In Social And Behavioral
Research, eds. Thousand Oaks, CA: Sage Publications.
Collis, J., & Hussey, R. (2013). Business Research: A Practical Guide for Undergraduate
& Postgraduate Students. Hampshire: Palgrave Macmillan.
Cormack, D. (1991). The Research Process in Nursing (2nd ed.). Oxford: Blackwell
Scientific.
Collis, J. & Hussey, R. (2009). Business Research: A Practical Guide For Undergraduate
& Postgraduate Students. New York: Palgrave Macmillan.
Creswell, J. (2003). Research Design: Qualitative, Quantitative And Mixed Methods
Approaches (2nd ed.). Thousand Oaks, CA: SAGE Publications.
Creswell, J. (2009). Research Design Qualitative, Quantitative and Mixed Methods
Approach. (3rd ed.). Thousand Oaks, CA: SAGE Publication.
Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The
Case Study Approach. BMC medical research methodology, 11, 100.
Cruz, N., Pérez, V.& Cantero, C. (2009). The Influence of Employee Motivation on
Knowledge Transfer. Journal of Knowledge Management, 13(6), 478-490.
Cummings, J. & Teng, B. (2003). Transferring R&D Knowledge: The Key Factors
Affecting Knowledge Transfer Success. Journal of Engineering and Technology
Management, 20(1-2), 39-68
Darr, E., & Kurtzberg, T. (2000). An Investigation of Partner Similarity Dimensions on
Knowledge Transfer. Organizational Behavior and Human Decision Processes,
82(1), 28-44
Dartey-Baah, K., (2011). The Impact Of National Cultures On Corporate Cultures In
Organisations. Academic Leadership Journal, 9(1).
165
Davenport, T., & Prusak, L. (2000). Working Knowledge: How Organizations Manage
What They Know. Retrieved from:
http://wang.ist.psu.edu/course/05/IST597/papers/Davenport_know.pdf
Dehghani, L., Ganjoo, M., Basirian Jahromi, R., Akhundzadeh, M., Ganjoo, M. (2013).
Investigating Methods of Transferring Tacit Knowledge among Nursing Experts of
Iranian Hospitals. International Journal of Information Science and Management,
11(2), pp.77-90.
DeLong, D., (2004). Lost Knowledge: Confronting the Threat of an Aging Workforce,
New York: Oxford University Press.
DeLong, D., & Fahey, L. (2000). Diagnosing Cultural Barriers to Knowledge
Management. Academy of Management Executive, 14, 113-127.
Denison, D. (1984). Bringing Corporate Culture to The Bottom Line. Organizational
Dynamics, 13(2), 5-12.
Denison, D. (1990). Corporate Culture and Organizational Effectiveness. New York:
Wiley.
Denison, D. (1990). Corporate Culture and Organizational Effectiveness. New York:
Wiley.
Denison, D., & Mishra, A. (1995). Toward A Theory Of Organizational Culture And
Effectiveness, Organization Science, 6(2), 204-223.
Denscombe, M. (2014). The Good Research Guide : For Small-Scale Social Research
Projects (Fifth Edition. Ed.): Maidenhead, Berkshire, England : Open University
Press.
Denton, K. (2011). Engaging your Employees in Times of Uncertainty. International
Journal of Productivity and Quality Management, 7(2), 202-208.
166
Deresky, H. (2014). International Management: Managing Across Borders And Cultures:
Text And Cases (8th ed.). New Jersey: Pearson Education.
Dilman, D. (2009) Internet, Mail, And Mized Mode Surveys: The Tailored Design
Method (3rd ed). New York: Wiley.
Dobbins M., DeCorby K., & Twiddy T. (2004). A Knowledge Transfer Strategy for
Public Health Decision Makers. Worldviews on Evidence- Based Nursing, 1(2),
120–128.
Dobrai, K., Farkas, F., Karoliny, K., & Poór, J. (2012) Knowledge Transfer in
Multinational Copmanies – Evidence from Hungary, Acta Polytechnica
Hungarica, 9(3), 149-161.
Domegan, C. & Fleming, D. (2003). Marketing Research in Ireland Theory and Practice.
Dublin: sGill & Macmillan.
Dowling, P., Festing, M., & Engle, A. (2008). International Human Resource
Management (5th sed.). London: Thomson Learning.
Edwards, P. (2010). Questionnaires in Clinical Trials: Guidelines for Optimal Design and
Administration. Trials, 11, 2.
Egan, T. (2008). The Relevance of Organizational Subculture for Motivation to Transfer
Learning. Human Resource Development Quarterly, 19, 299-322.
Ehin, C. (2008). Un-Managing Knowledge Workers. Journal of Intellectual Capital, 9(3),
337-350.
Eisner, E. ( 1993) Forms Of Understanding And The Future Of Educational Research.
Educational Researcher 22(7), 5 - 11.
Eisenhardt, K. (1989). Building Theories From Case Study Research. Academy Of
Management Review, 14, 532-550.
167
Ekore, J. (2014). Impact Of Key Organizational Factors On Knowledge Transfer Success
In Multi-National Enterprises, Management, 19(2), 3–18.
El Morr, C. & Subercaze, J. (2010). Knowledge Management in Healthcare. Handbook of
Research on Developments in E -Health and Telemedicine, Technological and
Social Perspectives, 490 － 510.
Evans, J., Brown, A., & Baker, G. S (2017). Organizational Knowledge And Capabilities
In Healthcare: Deconstructing And Integrating Diverse Perspectives. SAGE open
medicine, 5, doi:10.1177/2050312117712655.
Evans, J., & Mathur, A. (2005). The Value of Online Surveys. Internet Research, 15(2),
195-219.
Fang, T. (2003). A Critique of Hofstede’s Fifth National Culture Dimension.
International Journal of Cross-Cultural Management, 3(3), pp. 347–368.
Feet, V. & Naess, A. (2015). A Qualitative Study of Improvement and Knowledge
Transfer in Norwegian Public Hospitals. Retrieved from
https://pdfs.semanticscholar.org/96c8/ec080676ca8de9c6118c88f0e0d8c29ec551.p
df
Fei J, Chen S, & Chen S. (2009). Organisational Knowledge Base and Knowledge
Transfer in the Shipping Industry. Electronic Journal of Knowledge Management,
7(3), 325-340.
Fiss, P. (2009). Case Studies And The Configurational Analysis Of Organizational
Phenomena, in Byrne, D. and Ragin, C. (eds.) (2009) The SAGE Handbook of
Case-based methods, pp. 420-440.
Gill, T. (2013). Culture, Complexity, And Informing: How Shared Beliefs Can Enhance
Our Search for Fitness. Informing Science: The International Journal of an
Emerging Transdiscipline, 16, 71-98.
168
Gillespie, A., Denison, D., Haaland, S., Smerek, R, & Neale W. (2008). Linking
Organizational Culture and Customer Satisfaction: Result from Two Companies in
Different Industries. European Journal of Work and Organizational Psychology,
3(1), 13-24.
Girdauskiene, L., & Savaneviciene, A. (2012). Leadership Role Implementing
Knowledge Transfer In Creative Organization: How Does It Work? Procedia -
Social and Behavioral Sciences, 41, 15–22.
Goh, C. (2002). Managing Effective Knowledge Transfer: An Integrative Framework and
Some Practice Implications. Journal of Knowledge Management, 6(1), 23-30.
Gold, A. Malhotra, A., & Segars, A. (2000). Knowledge Management: An Organizational
Capabilities Perspective. Journal of Management Information Systems, 18(1), 185-
214.
Goodwin, L. & Goodwin, W. (1984). Qualitative vs. Quantitative Research Or
Qualitative And Quantitative Research? Nursing Research, 33(6), 378-380.
Grant, R. (1996). Toward A Knowledge-Based Theory Of The firm, Strategic Management
Journal, 17, 109-22.
Greener, S. (2008). Business Research Methods. London: Ventus Publishing.
Gregory, K. (1983). Native-view paradigms: Multiple Cultures And Culture Conflicts In
Organizations. Administrative Science Quarterly, 28, 359-376.
Groenewald, T. (2004). A Phenomenological Research Design Illustrated. International
Journal of Qualitative Method, 3(1), 1-26.
Hamidi, Y & Mohammadibakhsh, R., Soltanian, A., & Behzadifar, M. (2017).
Relationship Between Organizational Culture and Commitment of Employees in
Health Care Centers in West of Iran. Electronic Physician. 9(1), 3646-3652.
169
Hansen, M., Nohria, N., & Tiemey, T. (1999). What’s Your Strategy for Managing
Knowledge. Harvard Business Review, 7(22), 106-116.
Hauke, A. (2006). Impact of Cultural Differences On Knowledge Transfer in British,
Hungarian and Polish Enterprises. Retrieved from
https://ageconsearch.umn.edu/bitstream/12072/1/wp060050.pdf
Hillman, D. (2014). Understanding Multigenerational Work-Value Conflict Resolution.
Journal of Workplace Behavioral Health, 29, 240–257.
Hofstede, G., Hofstede, G. J., & Minkov, M. (2010). Cultures And Organizations:
Software Of The Mind (3rd. Ed.). New York, NY: McGraw-Hill.
Hofstede, G., Neuijen, B., Ohayv, D., & Sanders, G. (1990). Measuring Organizational
Cultures: A Qualitative and Quantitative Study Across Twenty Cases.
Administrative Science Quarterly, 35, 286–316.
Hofstede, G. (1991). Cultures and Organizations: Software of the Mind. London:
McGraw-Hill.
Hofstede, G. (1983). The Cultural Relativity Of Organizational Practices And Theories.
Journal Of International Business Studies,14(2),75-89.
Hofstede, G. (1980). Culture's Consequences: International Differences In Work-Related
Values. London: Sage Publications
Hofstede,G., Neuijen, D., Ohayv, D. & Sanders, G. (1990). Measuring Organizational
Cultures: a Qualitative and Quantitative Study across Twenty Cases.
Administrative Science Quarterly, 35, 286–316.
Hofstede, G. (1993). Cultural Constraints In Management Theories. The Academy of
Management Executive, 31,81-94.
Hofstede, G. (1997) Cultures and Organizations: Software of the Mind. London:
McGraw-Hill.
170
Hofstede, G. (2001). Culture’s Consequences (2nd ed.). USA: Sage Publications, Inc.
Hofstede, G. & Hofstede, G. (2005) Cultures and Organizations: Software of the Mind,
Intercultural Cooperation and Its Importance for Survival. UK: McGraw - Hill
Companies.
Hofstede, G. (2010). The GLOBE Debate: Back to Relevance, Journal of International
Business Studies, 41(8), 1339-1346.
Hofstede, G., Hofstede, J. & Minkov, M. (2010). Cultures and Organisations: Software of
the Mind. NY: McGraw Hill.
Hofstede, G. (2011). Dimensionalizing Cultures: The Hofstede Model In Context. Online
Readings in Psychology and Culture, 2(1).
Holten, A., Hancock, G., Persson, R., Hansen, A., & Høgh, A. (2016). Knowledge
Hoarding: Antecedent Or Consequent Of Negative Acts? The Mediating Role Of
Trust And Justice, Journal of Knowledge Management, 20(2), 215-229.
Hung, S., Huang, Y., & Chou, Y. (2015). Understanding the Factors Influencing
Physicians' Knowledge Transfer Success. Retrieved from:
https://pdfs.semanticscholar.org/7827/fda43faa2827a6f8d5902fcbd1d3a6baaf71.pd
f
Hunt, S., Sparkman, R., & Wilcox, J. (1982). The Pretest in Survey Research: Issues and
Preliminary Findings. Journal of Marketing Research,19, 269–73.
Husain, Z. (2013). Effective Communication Brings Successful Organizational Change.
The Business & Management Review, 3(2), 43-50.
Hwang, A. (2003). Training Strategies in The Management of Knowledge. Journal of
Knowledge Management, 7(3), 92-104.
Inkpen, A. & Tsang, E. (2005). Social Capital, Networks, and Knowledge Transfer.
Academy of Management Review, 30(1), 146-65.
171
Islam, M., Hasan, I., & Rahman, M. (2015). Factors Affecting Knowledge Transfer in
Public Organization Employees. Asian Social Science, 11(4), 223-233.
Jabr, N. (2007). Physicians' Attitudes Towards Knowledge Transfer and
Sharing. Competitiveness Review: An International Business Journal, 17 (4),.248-
260.
Javidan, M., House, R., Dorfman, P., Hanges, P. & De Luque. M. (2006).
Conceptualizing and Measuring Cultures and Their Consequences: A Comparative
Review of GLOBE’s and Hofstede’s Approaches. Journal of International Business
Studies, pp. 897–914.
Jasimuddin, S. , Klein, J. & Connell, C. (2005). The paradox of using tacit and explicit
knowledge. Management Decision, 43(1), 102-112.
Jelenic, D. (2011). The Importance of Knowledge Management in Organizations— With
Emphasis on the Balanced Scorecard Learning and Growth Perspective. Paper
presented at Management , Knowledge and Learning International Conference ,
Celje, Slovenia, 22-24 June 2011, 33-43.
Jih, W., Chen, C. & Chen, A. (2008). Knowledge Characteristics, Knowledge Acquisition
Strategy And Results Of Knowledge Management Implementations: An Empirical
Study Of Taiwanese Hospital. Current Issues In Knowledge Management. New
York: Information Science Reference.
Joia, L. & Lemos, B. (2010). Relevant Factors For Tacit Knowledge Transfer Within
Organisations. Journal Of Knowledge Management, 14(3), pp. 410-427.
Johnson, D., & Johnson, F. (2005). Joining together: Group theory and group skills (9th
ed.). Boston: Allyn & Bacon.
Johnson, R. & Onwuegbuzie, A. (2004). Mixed Methods Research: A Research
Paradigm Whose Time Has Come. Educational Researcher, 33 (7), 14-26.
172
Johns, G. (2006). The Essential Impact of Context on Organisational Behaviour.
Academy of Management Review 31(2), 386-408.
Jones, M. (2007). Hofstede - Culturally questionable? Retrieved from:
https://www.researchgate.net/publication/30389134_Hofstede_-
_Culturally_questionable.
Jones, K.& Leonard, L. (2009). From Tacit Knowledge to Organizational Knowledge for
Successful KM. In W.R. King (Ed). Knowledge Management and Organizational
Learning, Annals of Information Systems, 4, 27-39.
Jonsson, A. (2008). A Transnational Perspective On Knowledge Sharing: Lessons
Learned From IKEA’s Entry Into Russia, China And Japan. The International
Review of Retail, Distribution and Consumer Research, 18(1), 17-44.
Jung, J., Su, X., Baeza, M., & Hong, S. (2008). The Effect of Organizational Culture
Stemming from National Culture Towards Quality Management Deployment, The
TQM Magazine, 20(6), 622–635.
Kabir, N., & Carayannis, E. (2013). Big data, tacit knowledge and organizational
competitiveness. In Proceedings of the International Conference on Intellectual
Capital, Knowledge Management & Organizational Learning, 220-227.
Khatib, T. (1996). Organizational culture, subcultures, and organizational commitment.
Retrieved from https://lib.dr.iastate.edu/rtd/11540
Kasper-Fuehrer, E. & Ashkanasy, N. (2001). Communicating Trustworthiness And
Building Trust In Interorganizational Virtual Organizations. J. Manage.,
27(3),235-254.
Keller, H. (2017). Culture and Development: A Systematic Relationship. Perspectives on
Psychological Science, 12, 833–840.
173
Kirkman, B. , Lowe, K., & Gibson, C. (2006). A Quarter Century Of “Culture’s
Consequences”: A Review Of Empirical Research Incorporating Hofstede’s Cultural
Values Framework. Journal of International Business Studies, 37, 285-320.
Klees, S. (2017). Quantitative Methods in Comparative Education and Other Disciplines:
are they valid? Educação and Realidade, 42(3), 41-858.
Kotter, P., & Heskett, L. (1992). Corporate Culture and Performance. New York:
Macmillan.
Koudsi, S. (2000). Actually, It Is Like Brain Surgery. Fortune, 141(6), 233–234.
Kukkurainen M., Suominen T., Rankinen S., Harkonen, E., & Kuokkanen L. (2012)
Organizational Vision: Experience at The Unit Level. Journal of Nursing
Management, 20, 868–876.
Kumar, A. & Ganesh, L. (2009). Research on Knowledge Transfer in Organizations: A
Morphology. Journal of Knowledge Management, 13(4), 161-174.
Kuzel, A. & Like, R. (1991). Standards of trustworthiness for qualitative studies in
primary care. Retrieved from https://psycnet.apa.org › record
Ladd, D., & Heminger, A. (2003). An Investigation of Organizational Culture Factors
that May Influence Knowledge Transfer. In the Proceedings of the 36th Hawaii
International Conference on Systems Sciences.
Lam, A. (2000). Tacit Knowledge, Organizational Learning and Societal Institutions: An
Integrated Framework. Organization studies, 21(3), 487-513.
Labaree, R. (2009). Research Guides: Organizing Your Social Sciences Research Paper:
Quantitative Methods. Retrieved from
https://libguides.usc.edu/writingguide/quantitative
174
Lages, C., Pfajfar, G., & Shoham, A.(2015). Challenges In Conducting And Publishing
Research On The Middle East Andafrica In Leading Journals. International Marke
ting Review, 32(1), 5277.
Lai, K., Pratt, K., Anderson, M., & Stigler, J. (2006). Literature Review and Synthesis:
Online Communities of Practice. Retrieved from:
https://www.educationcounts.govt.nz/__data/assets/pdf_file/0019/7480/lrs-online-
com.pdf
Lang, J. (2001). Managerial concerns in knowledge management. Journal of Knowledge
Management, 5(1), 43-59.
Larsson, Marcus & Östberg, Erik. (2009). Critical factors for communication and
knowledge transfer: A study of Volvo Cars Corporation's Market Intelligence
Department and their communication and Interaction with their various Internal
Clients. Retrieved from: http://www.diva-
portal.org/smash/record.jsf?pid=diva2%3A293825&dswid=-1040
Lindholm, N. (2000). National Culture and Performance Management in MNC
Subsidiaries, International Studies of Management & Organization, 29(4), 5-66.
Li, T. (2015). Organizational culture and employee behavior. Thesis, Lahti University of
applied Sciences. Retrieved from
https://www.theseus.fi/bitstream/handle/10024/92815/LI_Tianya.pdf
Liew, A. (2007). Understanding Data, Information, Knowledge and Their Inter-
Relationships. Journal of Knowledge Management Practice, 8(2), 1-10.
Lin, L., Geng, X., & Whinston, A. (2005). A Sender–Receiver Framework for
Knowledge Transfer. MIS Quarterly, 29(2), 197-219.
Lok, P., Westwood, R., & Crawford, J. (2005). Perceptions of organizational subculture
and their significance for organizational commitment. Applied Psychology, 54(4),
490–514.
175
Loxton, M. (2014). Integrating Lessons Learned Processes for Improved Clinical
Outcomes. Integrating Lessons Learned Processes for Improved Clinical
Outcomes. Retrieved from https://www.maxqda.de/download/Loxton.pdf
Lucas, L. (2006). Things are Not Always What They Seem: How Reputations, Culture,
and Incentives Influence Knowledge Transfer. The Learning Organization, 13(1),
7-24.
Madu, B. (2011). Organizational culture as driver of competitive advantage. Journal of
Academic and Business Ethics, 5(1), 1- 9.
Mahmudi, R. & J. Kargaran (2016). Identifying The Factors Influencing Knowledge
Sharing Among The Staff, Tabriz Azad University, International Journal of
Humanities and Cultural Studies (IJHCS), ISSN 2356-5926, 2016: p. 19.2000-96.
Malat, J. (2011) Social Distance and Patient's Ratings for Health Care Providers. Journal
of Health and Social Behavior, 42(4), 360-72.
Malhotra,,N. & Birks, D. (2007). Marketing Research: an applied Approach (3rd ed.).
England: Prentice Hall.
Marakas, G. (1999). Decision Support Systems in the Twenty-first Century. Englewood
Cliffs, NJ: Prentice-Hall.
Mariia Makovetska, M., Anjoom, M. & Abbasi, S. (2017). The Effect Of Organizational
Culture On Knowledge Transfer Between Headquarters And Subsidiaries. Case
Study Of Scania. Retrieved from: www.diva-portal.org › smash › get ›
diva2:1112934 › FULLTEXT01
Martensson, M. (2000). A Critical Review of Knowledge Management as A Management
Tool. Journal of Knowledge Management, 4(3), 204-216.
Martin, J. (992). Cultures in Organisations: The Three Perspectives. New York: Oxford
University Press.
176
Mason, J. (2006). Mixing Methods In A Qualitatively Driven Way. Qualitative Research,
6(1), 9–25.
Mason, D., & Pauleen, D. (2003). Perceptions of Knowledge Management: A Qualitative
Analysis. Journal of Knowledge Management, 7(4), 38-48.
Martinez-Noya, A., Garcia-Canal, E., & Guillen, M. (2013). R&D Outsourcing and The
Effectiveness of Intangible Investments: Is Proprietary Core Knowledge Walking
Out of The Door? Journal of Management Studies, 50(1), 67–91.
Matijrvic, S, Raguux, I., & Filipovic, D. (2015). The Role Of National Culture In
Contemporary Business Environment. Dubtovnik International Economic Meeting,
2(1), 457-469.
Mead, N. & Bower, P. (2000). Patient-centredness: A Conceptual Framework and
Review of The Empirical Literature. Social Science & Medicine, 51, 1087–1110.
McCready, V. (2011). Generational Issues In Supervision And Administration. ASHA
Lead, 16, 12-15.
McDermott, R. (1999). Why Information Technology inspired, but Cannot Deliver
Knowledge Management. California Management Review, 41(4), 103-117.
McDermott, R, & O’Dell, C., (2001). Overcoming Cultural Barriers to Sharing
Knowledge. Journal of Knowledge Management, 5(1), 76-85.
McSweeney, B. (2002). Hofstede’s Model Of National Cultural Differences And Their
Consequences: A Triumph Of Faith–A Failure Of Analysis. Human Relations, 55,
pp. 89-118.
Mkansi, M & Acheampong, E. (2012). Research Philosophy Debates and Classifications:
Students' dilemma. Electronic Journal of Business Research Methods, 10, 132-
140.
177
Miller, C. (1995). In-depth Interviewing By Telephone: Some Practical Considerations,
Evaluation and Research in Education, 9(1), 29-38.
Minkov, M. (2011). Cultural Differences In A Globalizing World. Bingley, UK:
Emerald.
Minkov, M. (2018). A Revision Of Hofstede’s Model Of National Culture: Old Evidence
And New Data From 56 Countries. Cross Cultural & Strategic Management, 25, pp.
231-256.
Mohamed, M., Stankosky, M., & Murray, A. (2006). Knowledge Management and
Information Technology: Can They Work in Perfect Harmony. Journal of
Knowledge Management, 10(3), 103-116.
Mohr, N., Moreno-Walton, L, Mills, A., Brunett, P. & Promes, S. (2012). Generational
Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring,
and Technology (Part I). Academic Emergency Medicine, 18(2), 190–199.
Moyo, N. (2015). Conceptions of Knowledge Transfer in Organisations: A Bibliometric
and Content Analysis of three Journals. Retrieved from
https://pdfs.semanticscholar.org/089b/ab07e56c88194bf4e0f6b232c7089595ab6d.pdf
Mulvihill, C. & Haworth, N. (2005) Using the internet to collect survey data. Lessons
from a survey of older riders in Australia. Retrieved from https://acrs.org.au › files
› arsrpe
Najafi, L., Hamidi, Y., Ghiasi, M., & Emami, H. (2011). Performance Ealuation and Its
Effects on Employees' Job Motivation in Hamedan City Health Centers. Australian
Journal of Basic and Applied Sciences, 5(12), 1761-1765.
Nakata, C. (2009). Beyond Hofstede: Cultural frameworks for global marketing and
management. Basingstoke, UK: Palgrave MacMillan.
Neuman, W. (2000). Social Research Methods Qualitative And Quantitative Approaches
(4th ed.). Allyn & Bacon, Needham Heights.
178
Newman, K. (1996). Culture And Congruence: The Fit Between Management Practices
And National Culture. Journal of International Business Studies, 27(4), pp. 753.
Ngambi, H. (2011). The relationship between leadership and employee morale in higher
education. African Journal of Business Management, 5,762–776.
Nguyen, D. (2014). Organizational Culture: A Case Study of Standard Chartered Bank
(Vietnam) Ltd. Retrieved
from:https://www.theseus.fi/bitstream/handle/10024/85520/thesis%20final%20-
%20kien.nguyen.pdf?sequence=1
Nielsen, B. (2010). Strategic Fit, Contractual, and Procedural Governance in Alliances.
Journal of Business Research, 63(7),682– 689.
Nidhra,S. & Yanamadala, M. (2012). Knowledge Transfer Challenges and Mitigation
Strategies in Global Software Development. Retrieved from: www.diva-portal.org
› smash › get › diva2:829480 › FULLTEXT01
Nonaka, I. (1991). The Knowledge-Creating Company. Harvard Business Review, 69(6),
96-104.
Nonaka, I. (1994). A Dynamic Theory of Organizational Knowledge Creation.
Organization Science, 5(1), 14-17.
Nonaka, I. & Takeuchi, H. (1995). The Knowledge-Creating Company: How Japanese
Companies Create the Dynamics of Innovation. NY: Oxford University Press.
Novianto. O. & Puspasari, D. (2012). Knowledge Management System Implementation
in a Company with Different Generations: A Case Study. Procedia - Social and
Behavioral Sciences, 65, 942 – 947.
Oborn E., Barrett M., & Racko, G. (2010). Knowledge translation in healthcare: A review
of the literature. Cambridge, UK.
179
Ogbuigwe, T. (2013). Understanding International Business in the Context of Cultural
Lenses. Journal of Business and Management, 10(5), 35-44.
Okere, G. (2017). Barrier and Enablers of Effective Knowledge Management: A Case in
the Construction Sector. Retrieved from
http://www.ejkm.com/issue/download.html?idArticle=807
Ourfali, E. (2015). Comparison between Western and Middle Eastern cultures: Research
on why American expatriates struggle in the Middle East. Otago Management
Graduate Review, 13.
Pandey, S.C. & Dutta, A. (2013). Role Of Knowledge Infrastructure Capabilities In
Knowledge Management. Journal of Knowledge Management, 17(3),435-453.
Pathirage, C., Amaratunga, R. & Haigh, R. (2008).The Role of Philosophical Context in
the Development of Theory: Towards Methodological Pluralism. The Built and
Human Environment Review, 1, 1–10.
Patricia, O. (2015). Improving Interpersonal Relationship in Workplaces. IOSR Journal
of Research and Method in Education, 5(6), 115-125.
Patton, M. (1990). Qualitative Evaluation And Research Methods (2nd ed.). Newbury
Park, CA: Sage.
Pentland, D., Forsyth, K, & MacIver, D, (2011). Key Characteristics of Knowledge
Transfer and Exchange in Healthcare: Integrative Literature Review. Journal
of Advanced Nursing, 67(7), 1408–1425.
Potter, G. (2000). For Bourdieu, Against Alexander: Reality and Reduction. Journal for
the Theory of Social Behaviour, 30, 229–46.
Pyra, K. (2003) Knowledge Translation: A Review of the Literature, Halifax: Nova
Scotia Health Research Foundation.
180
O’Donnell, O. & Boyle, R. (2008). Understanding And Managing Organisational
Culture. Dublin, Ireland: Institute of Public Administration.
Odor, H. (2018). Organisational Culture and Dynamic. Global Journal of Management
and Business Research, 18(1), 23-29.
Olomolaiye, A. & Egbu, C. (2005). Tacit Vs. Explicit Knowledge – The Current
Approaches To Knowledge Management. Retrieved from:
http://www.irbnet.de/daten/iconda/CIB10682.pdf
Padilla-Diaz, M. (2015) Phenomenology in Educational Qualitative Research: Philosophy
as Science or Philosophical Science? International Journal of Educational
Excellence, 1(2), 101-110.
Park, C., Vertinsky, I., & Becerra, M. (2015). Transfers Of Tacit Vs. Explicit Knowledge
And Performance In International Joint Ventures: The Role Of Age. International
Business Review, 24, 89–101.
Patel, P. (2009). Introduction to Quantitative Methods. Retrieved from:
https://hls.harvard.edu/content/uploads/2011/12/quantitative_methods.pdf
Pentland, D., Forsyth, K., & MacIver, D. (2011). Key Characteristics of Knowledge
Transfer and Exchange in Healthcare: Integrative Literature Review. Journal
of Advanced Nursing, 67(7), 1408–1425.
Perrin, A. & Rolland, N. (2007). Mechanisms of Intra-Organizational Knowledge
Transfer: The Role of a Global Technology Firm. Management, 10(2), 25-47.
Piper L. (2005). Winning Loyalty with A Vision and a Corporate Soul. Health Care
Manager, 24 (4), 374–378.
Polanyi, M. (1958). Personal Knowledge towards a Post-Critical Philosophy. London:
Routledge & Kegan Paul.
181
Pothukuchi, V., Damanpour, F., Choi, J., Chen, C. & Park, S. (2002). National and
Organizational Culture Differences and International Joint Venture Performance,
Journal of International Business Studies, 33, 243-265.
Rafeet, K. (2010). Culture Diversity Management in The Healthcare Sector A Case
Study. Retrieved from https://bspace.buid.ac.ae/bitstream/1234/257/1/70013.pdf
Ragab, M. & Arish, A. (2016). Elements of Individual Knowledge: A Practitioner 's
Perspective. Retrieved from
https://arrow.dit.ie/cgi/viewcontent.cgi?referer=https://www.google.com.sa/&https
redir=1&article=1052&context=buschmancon
Rai, R. & Panna, K (2010). Introduction to Culture Studies. Retrieved from:
http://www.himpub.com/documents/Chapter978.pdf
Raguž, I., Zekan, S., & Peronja, I. (2017). Knowledge As A Source Of Competitive
Advantage In Knowledge Based Companies. Diem, 3(1), 533-544.
Rance, S. (2011), ITIL: Service Transition, 2nd ed., TSO, Norwich.
Randeree, E. (2006). Knowledge Management: Securing the Future, Journal of
Knowledge Management, 10(4), 145-156.
Reagans, R., & McEvily, B. (2003). Network Structure and Knowledge Transfer: The
Effects of Cohesion and Range. Administrative Science Quarterly, 48(2), 240-267.
Redpath, L. (1997). A Comparison Of Native Culture, Non-Native Culture And New
Management Ideology. Revue Canadienne des Sciences de l'Administration, 14(3),
pp. 327.
Renzl, B. (2008). Trust in Management and Knowledge Sharing: The Mediating Effects
of Fear and Knowledge Documentation. Omega, 36, 206-220.
Rezvani, Z. (2017). Who Is a Middle Manager: A Literature Review. International
Journal of Family Business and Management, 1(2), 1–9.
182
Rhodes, J., Hung, R., Lok, P., Lien, B., & Wu, C. (2008). Factors Influencing
Organizational Knowledge Transfer: Implication for Corporate Performance.
Journal of Knowledge Management, 12(3), 84–100.
Ridder, H. (2017). The Theory Contribution Of Case Study Research Designs. Business.
Research, 10, 281–305.
Riusala, K. & Smale, A. (2007). Predicting Stickiness Factors In The International
Transfer Of Knowledge Through Expatriates. International Studies of
Management and Organization,37(3),16-44.
Robbins, N. (2003). Ideas for Invigorating morale in higher education. CUPA-HR J.
54(2), 19-21.
Room, D. (2012). Knowledge Transfer Needs and Methods Final Report. Retrieved from:
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.392.7473&rep=rep1&ty
pe=pdf
Roth, J. (2003). Enabling Knowledge Creation: Learning From an R&D Organization.
Journal of Knowledge Management, 7(1), 32-48.
Sackmann, S. A. (1991). Uncovering culture in organizations. Journal of Applied
Behavioral Science, 27(3), 295-317.
Saldana, J. (2012). The Coding Manual For Qualitative Researchers. London: Sage.
Sale, J., Lohfeld, L., & Brazil, K. (2002). Revisiting the Quantitative-Qualitative Debate:
Implications for Mixed-Methods Research. Quality and Quantity,36(1), 43-53.
Saudi Vision 2030 (2016). Kingdom of Saudi Arabia, Vision 2030. Retrieved from:
http://vision2030.gov.sa/download/file/fid/417
Saunders, M., Lewis, P., & Thornhill, A. (2007). Research Methods for Business
Students (4th ed.). Pearson Education Ltd., Harlow.
183
Saunders, M., Lewis, P., & Thornhill, A. (2012) Research Methods for Business
Students. Pearson Education Ltd., Harlow.
Saunders, M., Lewis, P., & Thornhill, A. (2016). Research Methods for Business
Students (7th ed.). Pearson Education Ltd, Harlow.
Schein, E (1985). Organizational Culture and Leadership: A Dynamic View. San
Francisco: Jossey Brass Publishers.
Schein, C. (1988). Organizational Culture and Leadership: A Dynamic View. San
Francisco: Jossey Brass Publishers.
Schneider, U. (2007). Coping with the Concept of Knowledge. Management Learning,
38(5), 613-633.
Schomaker, M., & Zaheer, S., (2014). The Role of Language in Knowledge Transfer to
Geographically Dispersed Manufacturing Operations. Journal of Internal
Management, 20 (1), 55–72.
Schubert, P., Lincke, D., & Schmid, B. (1998). A Global Knowledge Medium as a
Virtual Community: The NetAcademy Concept. In Proceedings of The Fourth
Americas Conference on Information Systems, Baltimore, MD.
Schwartz, S. (1999). A Theory Of Cultural Values And Some Implications For Work.
Applied Psychology, 48(1), pp. 23-47.
Schwartz, D. (2007). Integrating Knowledge Transfer and Computer-Mediated
Communication: Categorizing Barriers and Possible Responses. Knowledge
Management Research & Practice, 5, 249-259.
Senge, P. (2006). The Fifth Discipline: The Art & Practice of the Learning Organization.
London: Random House.
184
Serenko, A., & Bontis, N. (2016). Understanding counterproductive knowledge behavior:
antecedents and consequences of intra-organizational knowledge hiding, Journal
of Knowledge Management, 20(6),1199-1224.
Shahmoradi, L. Safadari, R., & Jimma, W. (2017). Knowledge management
implementation and the tools utilized in healthcare for evidence-based decision
making: a systematic review. Ethiopian Journal Of Health Science, 27(5), 541-58.
Shailashree, V.& Mlembra, E. (2016). Impact of National Culture on organization
Culture. International Journal of Scientific Research and Modern Education
(IJSRME), 1(1), 820-825.
Shen, B. (2016). Intergenerational Knowledge Transfer in Knowledge-Intensive
Enterprises. International Journal of Simulation--Systems, Science & Technology,
17(46).
Sheng, M., Chang, S., Teo, T. & Lin, Y. (2013). Knowledge Barriers, Knowledge
Transfer, And Innovation Competitive Advantage in Healthcare Settings.
Management Decision,51(3), 461-478.
Silverman, D. (2013). Doing Qualitative Research: A Practical Handbook: SAGE
Publications Limited.
Sibte, S. & Abidi, R. (2007). Healthcare Knowledge Management: The Art of the
Possible. Retrieved from:
https://www.researchgate.net/publication/221450292_Healthcare_Knowledge_Mana
gement_The_Art_of_the_Possible
Smith, P. B., Dugan, S., & Trompenaars, F. (1996). National culture and the values of
organizational employees: A dimensional analysis across 43 nations. Journal of
Cross-Cultural Psychology, 27, 231-264.
Smith, M. (1998). Culture and Organisational Change. Management Accounting, 76(7),
pp. 60.
185
Søndergaard, M. (1994). Hofstede's consequences: A Study Of Reviews, Citations And
Replications. Organization Studies, 15(3), pp. 447.
Song, J. & Chermack, T. (2008). A Theoretical Approach to the Organizational
Knowledge Formation Process: Integrating the Concepts of Individual Learning
and Learning Organization Culture. Human Resource Development Review, 7,
424-442.
Spender, J. (1996). Organizational Knowledge, Learning And Memory: Three Concepts
In Search Of A Theory. Journal of Organizational Change Management, 9, 163-
79.
Spencer-Laschinger, H. , Finegan, J., & Shamian, J. (2001). The Impact Of Workplace
Empowerment, Organizational Trust On Staff Nurses’ Work Satisfaction And
Organizational Commitment. Health Care Management Review, 26(3), 7–23.
Steiger, J., Hammou, K., & Galib, M. (2014). An Examination of the Influence of
Organizational Structure Types and Management Levels on Knowledge
Management Practices in Organizations. International Journal of Business and
Management, 9(6).
Susanty, A., Handayani, N., & Henrawan, M. (2012) Key Success Factors That Influence
Knowledge Transfer Effectiveness: A Case Study of Garment Sentra at Kabupaten
Sragen. Procedia Economics and Finance, 4, 23-32.
Szulanski, G. (1996). Exploring Internal Stickiness: Impediments to the Transfer of Best
Practice Within the Firm. Strategic Management Journal, 17, 27-43.
Szulanski, G. (2000). The Process of Knowledge Transfer: A Diachronic Analysis of
Stickiness. Organizational Behavior and Human Decision Processes, 82, 9-27.
Tharp, B. (2009). Defining “Culture” and “Organizational Culture”: From Anthropology
to the Office. Retrieved from:
http://www.thercfgroup.com/files/resources/Defining-Culture-and-Organizationa-
Culture_5.pdf
186
Taylor, B., Sinha, G., and Ghoshal, T., (2006), Research Methodology: A Guide for
Researchers in Management and Social Sciences, Prentice Hall of India Private
Limited, New Delhi.
The Economist (2009). Span of Control. Retrieved from:
https://www.economist.com/news/2009/11/09/span-of-control
Thomas, P. (2010). Towards Developing a Web-based Blended Learning Environment at
the University of Botswana. Retrieved from:
http://uir.unisa.ac.za/bitstream/handle/10500/4245/00Title%20page.pdf?sequence=
1&isAllowed=y
Thomas, T. & Pretat, C. (2009). The Process of Knowledge Transfer. Retrieved from:
https://www.researchgate.net/publication/325122097_Knowledge_Transfer_Practi
ce_in_Organization
Thomas, J., Kellogg, W., & Erickson, T. (2001). The Knowledge Management Puzzle:
Human And Social Factors In Knowledge Management. IBM Systems Journal,
40(4), 863 – 884.
Thorpe, R., & Holt, R. (2008) The Sage dictionary of qualitative management research.
London: Sage.
Trice, H. & Beyer, J. (1993). The Culture Of Work Organizations. Englewood Cliffs,
N.J: Prentice-Hall.
Tsai, W. (2002). Social Structure of “Coopetition” Within a Multiunit Organisation:
Coordination, Competition, and Intraorganizational Knowledge Sharing.
Organization Science, 13, 179-190.
Tsai, Y. (2011). Relationship Between Organizational Culture, Leadership Behavior and
Job Satisfaction. BMC Health Services Research, 11, (98),
http://doi.org/10.1186/1472-6963-11-98.
187
Tull, D. & Hawkins, D. (1976). Marketing Research Meaning, Measurement, and
Method, New York: Macmillan Publishing Co., Inc.
Van Maanen, J., & Barley, S. (1985). Frajgments of a theory, (pp. 31-55). In Frost, P. L,
et al. (Eds.). Organizational culture. Beverly Hills, CA: Sage.
Van Teijlingen, E. & Hundley, V. (2002). The Importance of Pilot Studies. Nursing
Standard, 16, 33-36.
Venaik, S. & P. Brewer. (2013). Critical Issues in The Hofstede and Globe National
Culture Models. International Marketing Review, 30 (5), pp. 469–482.
Von Krogh, G. (1998). Care in Knowledge Creation. California Management Review,
40(3), 133-153.
Warren, C. (2002). Qualitative interviewing. In Jaber F. Gubrium and James A. Holstein
(Eds.), Handbook of interview research: Context and method. Thousand Oaks, CA:
Sage.
Watkins K. & Marsick, V. (1996) In Action: Creating the Learning Organization.
Alexandria, VA: American Society for Training and Development.
Welman, J. & Kruger, S. (1999). Research Methodology for The Business and
Administrative Sciences. Johannesburg. South Africa: International Thompson.
Wilkesmann, U., Wilkesmann, M. & Virgillito, A. (2009). The Absence of Cooperation
is Not Necessarily Defection: Structural and Motivational Constraints of
Knowledge Transfer a Social Dilemma Situation, Organization Studies,
,https://doi.org/10.1177/0170840609344385
Wing, S. (2003). Objectivity and Ethics in Environmental Health Science. Environmental
Health Perspectives, 111(14), 1809–181.
Wisdom, J. & Creswell, J. (2013). Mixed Methods: Integrating Quantitative and
Qualitative Data Collection and Analysis While Studying Patient-Centered
188
Medical Home Models. Rockville, MD: Agency for Healthcare Research and
Quality. February 2013. AHRQ Publication No. 13-0028-EF.
World Health Organization (2000). The World Health Report 2000: health systems:
improving performance. Geneva: World Health Organization.
Yin, R. (1994). Case Study Research, Design and Methods: : Applied Social Research
and Methods (2nd ed.). Thousand Oaks, CA: Sage Publications Inc.
Yin R. (2009). Case Study Research: Design and Method (4th ed.). Thousand Oaks, CA:
Sage Publications Inc.
Yin, R. (2014). Case Study Research, Design and Methods (5th ed.). Thousand Oaks, CA:
Sage Publications Inc.
Younus, M. (2014). Research Methodology. In Vulnerability and Adaptation to Climate
Change in Bangladesh. Retrieved from https://link.springer.com › book
Zander, U., & Kogut, B. (1995). Knowledge and the Speed of the Transfer and Imitation
of Organizational Capabilities: An Empirical Test. Organization Science, 6, 76-92.
189
Appendices
Appendix 1: Invitation Email to Participate in Questionnaire
Invitation to Participate in Research Questionnaire
Dear participant,
I am a doctoral student from the University of Leicester, and I am conducting a research
study as part of my doctoral degree requirements. You are invited to participate in a
research titled the Impact of Organizational Culture on Knowledge Transfer Practices in
Health Care in Saudi Arabia. The main objective of this research is to understand the
impact of organizational culture factors and dimensions on the process of knowledge
transfer in a health care organization. The results of this research will assist in identifying
the most effective knowledge transfer practices in health care.
By agreeing to participate in the study, you are giving your consent for the researcher to
include your responses in data analysis and thesis. This research involves completing an
online questionnaire that only takes 10 minutes to complete. The survey link will be
emailed to you a week later in a separate email. This questionnaire will give you the
opportunity to express your opinion on the knowledge transfer practices implemented in
your organization and the organizational culture dimensions as they relate to health care.
Participation is completely voluntary and you may withdraw at any time. This research is
completely anonymous; therefore, you will not be asked to provide your name or any
other information. The questionnaire will be used to collect data for the research and the
study results will be strictly used by the researcher for research purposes only.
Your participation in the research is extremely appreciated.
Thank you for your time, support, and participation.
Sincerely,
Rania
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Appendix 2: Research Questionnaire
Knowledge Transfer in Health Care
You are invited to participate in a research study conducted by a doctoral student titled
“The Impact of Organizational Culture on Knowledge Transfer in Health Care”. In this
questionnaire, you will be asked to complete a few questions related to the current
knowledge transfer practices implemented by your organization. This questionnaire is
anonymous and takes about 10 minutes to complete. Your time is much appreciated.
*1. What is your gender?
Female
Male
*2. What is your nationality
*3. Number of years of service in your current organization?
*4. Have you ever worked in another organization?
Yes
No
If your answer is yes, indicates what type of organization
*5. What is the highest level of education you have completed?
High School
Higher Diploma
Bachelors
191
Masters
Doctorate/ PhD
Other
*6. What is your current work location?
Abqaiq
Dhahran
Hasa
Ras Tanura
Udailiyah
*7. Management level
Senior level (Report to C-Suite)
Middle level (One level between you and C-Suite)
Lower level (more than one level between you and C-Suite)
*8. How many employees directly report to you?
*9. How many employees indirectly report to you?
*10. Are the organization's mission and vision clear to you?
Yes
No
Please explain how the mission and vision were communicated to you
192
*11. Are the organization's mission and vision clear to your employees?
Yes
No
I don't know
Please explain how the mission and vision were communicated to your employees
*12. Please indicate to what extent you agree or disagree with the following
statements-
Strongly
Agree Agree Neutral Disagree
Strongly
Disagree
1 The organization encourages employees to
be innovative and take initiatives
2 The organization’s goals are realistic
3 The organization values and utilizes each
individual’s unique strengths and different
abilities.
4 The department/unit has clearly defined
goals that align with the organization’s
main goals
5 Employees are adaptable to changes within
organization.
6 Organizational changes are poorly
communicated with the employees
7 Meeting the needs of customers/patients is
considered the highest priority
8 Employees are encouraged to work in
teams.
9 Customers/ patients are considered each
employee’s responsibility.
10 Employees' personal goals are aligned with
the organization's mission and vision
11 Employees have open access to
information regarding the organization’s
performance
193
Strongly
Agree Agree Neutral Disagree
Strongly
Disagree
12 Management demonstrates concern for the
welfare of the employees
13 Management consults with employees on
issues that affect them
14 Employees are encouraged to provide
honest feedback to one another
15 Employees are empowered to do their jobs
16 The organization provides incentives to
motivate employees to perform
Other (please specify)
*13. Have you attended any educational courses in the last 3 months?
Yes
No
If the answer is yes, how many and were they work-related
*14. Are you satisfied with the knowledge transfer practices implemented in your
department?
Yes
No
Please indicate the reason behind your answer
194
*15. Please indicate the degree of importance of the following statements to
knowledge transfer
Statement
Strongly
Agree Agree Neutral
Disagre
e
Strongly
Disagree
1 Shadowing other employees
2 Reviewing the unit’s operating manuals,
policies and procedures
3 Socializing and interacting with other staff
members within the unit
4 Interacting with staff members outside the
department
5 Attending lectures, courses and seminars
6 Accessing online resources
7 Regular communication with the supervisor
8 Short-term assignments in other
departments within the organization
9 Asking guidance from experienced senior
employees
10 Enrolling in continuing education
programs/ courses
11 Networking internally within the
organization
12 Networking externally outside the
organization
13 Interacting with external consultants
Other (please specify)
*16. Briefly explain the reasons behind your rating to the previous question
Thank you!!
195
Appendix 3: Semi-structured Interview Questions
Interview Questions
Demographics
• What is your professional/work title today? Could you describe your position and
duties in the organization?
• How many years have you worked in the health care area?
• When did you start working at this organization?
• How do you develop professionally and personally at work?
• Have you accrued a higher level of knowledge since you started working here?
• What is your highest qualification?
Organizational Culture (OC) and the Work Environment
• How would you define OC?
• Could you describe to me your work environment ? (the atmosphere, the
relationship and cooperativeness of the employees)?
• How would you describe the culture of your organization?
• Do you feel that the atmosphere differs between different groups? (e.g.
older/younger, experienced/unexperienced, different professions, gender) How?
• The findings of the questionnaire suggested meeting the needs of customers and
patients has a significant impact on organizational culture. Do you agree that OC
influences knowledge transfer? How?
Knowledge Transfer (KT)
• How do you see KT in your organization?
• The findings of the questionnaire suggested that organizational management and
communication are amongst the main factors that affect the transfer of
knowledge. Do you agree with this statement and why?
• How do you transfer knowledge to other employees? How does the organization
encourage employees to KT?
• From your perspective what are the barriers to effective transfer the knowledge?
196
• How does your organization communicate mission, vision, and objectives to
employees? Does your organization/ department encourage employees to transfer
knowledge? How?
• What are some activities which can carried out in the organization to encourage
KT?