ABSTRACT
Questions regarding the nature of organizational knowledge draw upon a variety of communication theories and cut across a range of organizational settings and industries. As Kuhn and Jackson (2008) have shown, conceptions of organizational knowledge take two general forms. The first views knowledge as a defined, objective body of information derived through the use of formalized, deductive principles. From this perspective, knowledge “management” comprises the precise documentation, storage, assessment, and retrieval of information, optimizing its timely and accurate distribution and accessibility to relevant members and divisions of the organization. The second approach challenges the notion of knowledge as a fixed, objective body of information. Instead, this perspective sees knowledge as fluid, dynamic, and continually under revision, perpetually emerging through communication, action, and events (see Kuhn and Jackson, 2008, for a complete review). Put another way, the first perspective sees knowledge management mainly as a matter of creating and retrieving records, while the second emphasizes the importance of continuous, just-in-time access to networks of relationships (Steier & Eisenberg, 1997). Eisenberg (2008) draws a similar distinction between transmissionbased and social construction models of communication in the context of health care teams. Rather than treating the two models as mutually exclusive, he examines the definitions and criteria for effectiveness for each, demonstrating their applicability to particular situations (e.g., sometimes it is useful to think of knowledge in terms of transmission, other times as ongoing social construction). In this chapter, we expand upon this idea to promote a more nuanced understanding of organizational knowledge management as it relates to health care. In a fashion that echoes Joanne Martin’s (1992) description of three perspectives in organizational culture research, our approach begins by identifying three frameworks of analysis for organizational knowledge and communication in health care: routinized, emergent, and political. After elaborating on these three frameworks, we demonstrate the value in considering how all three interact with one another in dimensional pairings
and tensions. To do this, we draw from a rather unique data set: the transcripts of a two-day retreat of an interdisciplinary research team. The purpose of the meeting was to make sense of a large amount of observational data on physician transitions and decision-making in emergency rooms. In a sense, we are providing a method of nested reflections as we reflect on their reflections on health care. What we discovered in these reflections was a compelling example of collective sensemaking that may have broad utility as a model for sensemaking in health care organizations.
Three Frames of Knowledge
