1. Marie-France Duranceau University of Montreal AEA-Anaheim November 5th 2011 Knowledge Creation in Healthcare Organizations as a Result of Individuals’ Participation in the EXTRA and SEARCH Programs

2. Research project on organizational knowledge creation Principal learnings on capacity building in organization Focus of Presentation

3. Project funded by Canadian Health Services Research Foundation (CHSRF) and former SEARCH Canada; Multidisciplinary team of investigators; 6 sites: 3 in Alberta, 1 Saskatchewan, 1 Québec and 1 Nova Scotia; 88 interviews with fellows, supervizors, CEO, colleagues; Analysis of documents. Background

4. Same goal, different strategies

5. 1. What was the nature and the extent of the impact on the organizations of having a number of mid and senior-level managers trained through EXTRA and/of SEARCH? 2. What were the organizational processes through which the programs’ impact occured? 3. What were the contextual conditions that facilitated or impeded the programs’ impact? Research questions

9. Did interviewees notice changes in the use of EIDM in their organizations? Marked changes in the attitudes of others in the organizations towards the use of EIDM. Interviewees were able to see changes primarily in the language used Very limited changes in the skills acquired by others in the organizations for engaging in EIDM 1.3 Changes in the use of EIDM at the organizational level

11. 2. What were the organizational processes through which the programs’ impact occured? Transfer processUtility of processContextual conditions Socialization  Gain local knowledge  Strengthen attitudes  Gain credibility  Fellow’s leadership  Fellow’s role ( mid- /senior-level manager)  Structure of the training program  Existence of collaborative network Socialization: a process of converting new tacit knowledge through shared experiences and observations we were looking for: EXTRA fellows and SEARCHers involved in meaningful social interactions with others in their organizations we observed: all were involved in socialization processes with varying degrees of intensity before, during, and after their training requirement of management positions

12. 2. What were the organizational processes through which the programs’ impact occured? Externalization: a process of transforming tacit knowledge into explicit knowledge. Explicitation of knowledge through formal communication tools. To develop a common understanding of a problem/solution/situation we were looking for: EXTRA fellows and SEARCHers finding formal opportunities (meetings, seminars, presentations, publications) to communicate with colleagues about their attitudes and skills we observed: all used communication tools in order to make presentations about their individual or group projects; more robust externalization with EXTRA intervention projects than with SEARCH individual projects. Transfer processUtility of processContextual conditions Externalization  Voice engagement with EIDM (transfer of attitudes)  Show skills in the use of EIDM  Fellow’s leadership  Scope and relevance of intervention project;  Organizational communication culture

13. 2. What were the organizational processes through which the programs’ impact occurred? Combination: a reconfiguration or construction of new knowledge into a more complex form (from explicit to explicit). Interaction with others, their engagement and participation required to create new knowledge we were looking for: occasions where EXTRA fellows or SEARCHers would involve others in the actual practise of EIDM, most convincingly in contexts not related to IPs we observed: little combination, except in some IPs and a few other rare cases Transfer processUtility of processContextual conditions Combination  Necessary for transfer of skills  Collaborative networking  Learning culture and practices  Organizational leadership and support  Organizational upheaval(stability)  Motivation for team work  Flexible organizational arrangements (organicity)

14. 2. What were the organizational processes through which the programs’ impact occured? Internalization: “learning by doing.” Actualization of knowledge transfer through practice and action. When people internalize new knowledge, it becomes part of their tacit knowledge. we were looking for: changes in the practice of EIDM in organizations, whereby individuals other than the EXTRA fellows and SEARCHers employed EIDM we observed: adoption of attitudes towards EIDM but no transfer of skills Transfer processUtility of processContextual conditions Internalization  A first step towards routinization of the use of EIDM  Learning processes and practices  Skills and knowledge resources in the organization  Organizational upheaval  Chief executive officer leadership

16. 3. What were the contextual conditions that facilitated or impeded the programs’ impact? Organizational impact plausible in some contexts and in some instances Transfer of attitudes easier to achieve than the transfer of skills.

17. Combination 4 modes of knowledge conversion are necessary BUT combination is the sore spot in the transfer of EIDM skills Multiple pattern of interactions need to design ways to help people engage and participate in activities and projects in their organizations. Contextual conditions Learning culture, collaborative networking, flexibility (culture of adaptation and change in the organization). What did we learn about capacity building ?

18. Do we need a “critical mass”? critical mass seems to be less of an issue for the transfer of attitudes, which was achieved when EXTRA fellows and SEARCHers held central and/or leadership positions in their organizations on the rare occasions it occurred, skills transfer was limited to a close circle around the fellow or SEARCHer: a high number of program participants may be required to achieve an organizational impact on skills. What did we learn about capacity building ?

19. marie-france.duranceau@umontreal.ca Thank you ! Merci