CROSS-SECTOR COMMUNICATION


Barriers to knowledge-sharing among NHS EFM departments Boundary (Source & Recipient)


l Diverse educational backgrounds of EFM Managers/ Directors


l Perceived lack of time and priority for knowledge-sharing


l Job security from retaining knowledge for operational staff


Knowledge l Successes and failures are not effectively shared


l Know-what and know-why are often communicated well, whereas dissemination of know-how (tools and mechanisms) and know-who (expert directory) is often insufficient


l There is need to understand the replicability of pieces of information across multiple Trusts


Organisational context


l Deeply embedded silo-working due to complexities related to different building ownership and outsourcing models


l Varying board representation of EFM Directors l Inter-Trust competition inhibits open communication


Flow mechanisms


l Long approval processes to update official guidance (HBNs and HTMs)


l Fragmented communication structures due to reorganisations (e.g. abolishment of NHS Estates in 2004)


l Overarching structure for knowledge-sharing processes in the NHS needs more consistency


Figure 6: The summary of barriers reveals many issues that have been discussed frequently in the past, but have not yet been sufficiently addressed.


I. Case study on oxygen knowledge during COVID-19 What? How?


Where?


With whom? When?


Estates Managers, APs, and AEs December 2021 – May 2022


II. Delphi study on existing barriers and potential channels What? How?


Where?


Finding consensus on most common barriers 2-3 rounds of online questionnaires Online, sent to NHS Trusts in England


With whom? EFM staff When?


June – November 2022


Figure 7: Future research stages to uncover and drive understanding of the knowledge-sharing process and underlying barriers.


suggested that operational staff may gain a feeling of job security from retaining knowledge. In addition, potential tension exists between generations of EFM managers – the new generation with a management background and potentially less engineering-specific knowledge, and the traditional generation who have worked in their Trust and/or the wider NHS for decades. As a result, the former might struggle to effectively identify and communicate their knowledge needs with the latter.


The organisational environment Besides the knowledge boundary itself, the outcome of knowledge-sharing processes is also influenced by the organisational environment. Ideally, an organisational culture should promote connections and knowledge activities, and actively encourage staff to use and value knowledge.9


However, punitive


environments can discourage staff from sharing problems.7


This was reflected by


EFM practitioners, who mentioned that they often refrain from sharing best practice because ‘if anything goes wrong, I don’t want to be the one who’s blamed’. In addition, the political standings of EFM departments vary among Trusts, depending on the extent of board-level


60 Health Estate Journal November 2021


representation, leading to varying degrees of autonomy and support. Moreover, differences in ownership (e.g. PFI) and outsourcing models create organisational complexities which lead to deeply embedded ‘silo-working’, not only among hospitals, but also among departments and teams in individual Trusts. This is further reinforced by inter- organisational competition due to the inter-Trust benchmarking, which often causes EFM staff to ‘hold things a little bit closer to their chest’.


Tracking flows of different knowledge types in hospitals Semi-structured interviews and document analysis 4-6 NHS Trusts in England


Fear of perceived ‘failures’ When asked about the knowledge transferred, interviewees predominantly mentioned a lack of sharing successes and failures, and suggested that this may be due to a fear among EFM staff that sharing their ‘failures’ […] ‘makes them look bad’, while sharing their wins could mean that ‘somebody will belittle it or contradict them’. This means that the know-what and know-why for ‘Net Zero’ interventions are often well


communicated by NHSE/I, whereas the sharing of know-how – which is mostly generated through problem-solving and is essential to implement the required interventions – is often insufficient. To be able to share know-how, interviewees emphasised the need to understand whether a contextual piece of information is ‘replicable across multiple Trusts’. As discussed previously, there are various mechanisms to enable better knowledge flows among NHS EFM departments. However, a holistic strategy and consistent structure of the different channels is missing. Multiple NHS reorganisations have led to a loss of forums where EFM staff can collaborate. For example, ‘NHS Estates’ – the former arm’s length body – had a central role in disseminating knowledge and fostering collaboration among NHS Trusts.10


Dimensions of knowledge from MGPS domain Characteristics


Type Semiotics


Generalisability Ownership Durability


Know-what Know-why


Documented (Explicit) General (Global) Individual Durable


Maximum throughput of bulk oxygen evaporator (L/min)


Legend


Basic understanding of fluid dynamics and implications on operational limits of MGPS


Classification Know-how Know-who


Undocumented (Tacit) Specific (Local)


Collective (Team, dept & org.) Dynamic


Required changes to de-icing routine of O2 evaporator in response to higher throughput


Suitable suppliers of ultrasonic gas flowmeters for MGPS


Figure 8: Explanation of different knowledge characteristics with examples from the MGPS domain.


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