Extensive field notes from the observation sessions were collated immediately after each observation session.
This approach was used as no model for the use of information and communication technology in the context of community aged care currently exists. Two members of the research team undertook independent close reading of the interview transcripts and observation session field notes, and met to discuss key work processes themes described in the data.
The effects of applying information technology on job empowerment dimensions
Any differences in the nature of the information exchange processes modelled were discussed during team meetings. The preliminary findings on each aspect of the exploration were relayed back to a committee of three experts within Uniting over six additional meetings spanning twelve months. These three experts were senior members of staff involved in the Community Aged Care and Clinical Governance divisions of Uniting.
This provided the opportunity for validation of the findings. So when we do start making traction and getting information, [it] gets lost or not transposed. Care Workers enter information about the services they provided to clients. Case Managers enter information about client assessments and updates to care plans.
Customer Service Officers use the information entered by Care Workers and Case Managers to manage changes to client care service rosters. All groups of professionals could identify the roles and responsibilities of other groups. This indicates the existence of inter-professional partnerships in the pursuit of quality for care to aged care clients. We have got care workers, clients, case managers, service managers, agency staff as well. So we basically liaise with all these people. And it is basically to provide services to our clients. The model derived from the data can be found in Figure 2.
The main dimensions that support the roster are: information about the preferences of clients receiving services Clients , the services available from Uniting Services , and the preferences of Care Workers who provide services Care Workers. An algorithm within the software combines these dimensions to produce the service roster by considering the service needs of the client, and which Uniting employees are qualified to provide the services.
One Customer Service Officer described the client journey through care and the nature of their role in this journey. We get a referral from ACAT [Aged Care Assessment Team]…depending on availability, [the client] will be allocated to a service outlet…the Service Managers will decide whether to take on board this client. It needs to be with this type of care worker for this — preferably at this time. And we need to try and match that. And then the team over here will create the roster, try and get the appropriate care workers and other care done. Figure 2 also demonstrates the information exchange flows between Customer Service Officers and clients, Case Managers, and Care Workers.
Customer Service Officers were the primary contact for all parties about the service provision roster. Clients called them to raise issues with their service arrangements, for example if a Care Worker had not arrived for a planned service. Care Workers called them if they were unable to work, or if they arrived to deliver a service and the client was not home.
Case Managers called Customer Service Officers to ask questions about the roster for particular clients, or to request changes to the Care Worker assigned to a client. Conversely, Customer Service Officers called clients to renegotiate service times if a Care Worker was unable to cover their scheduled service. They called Care Workers about providing additional services that were not already allocated to a Care Worker.
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Finally, Customer Service Officers notified Case Managers when clients requested to speak with them, when a Care Worker could not be found to cover a service, or when a Care Worker was having trouble providing a scheduled service. The centralised service centre had introduced an unexpected information exchange barrier between clients and care staff.
Instead, they called a Customer Service Officer, who passed on their message to the Case Manager, who then returned the call. Previously, Case Managers coordinated services provided by Care Workers in their region. Clients and Care Workers were also able to call their Case Managers directly. This was rectified following the proof of concept test and pre-implementation communication channels were restored. Case Managers and Care Workers at the proof of concept sites had stopped directly communicating with one another, because they had been told that the centralised service centre would manage their communication instead.
After the unmanageable volume of calls to the service centre became apparent, care staff at these sites had to be instructed to resume contacting each other directly. Two examples of a disruption in information exchange were described by Customer Service Officers. The first disruption arose when Customer Service Officers attempted to roster services, depicted by a dashed arrow in Figure 2 between Care Worker and Client information dimensions.
One of the Customer Service Officers described issues with the quality of the data that prevented this functionality from operating. And that is why it is not able to generate that list. The Program Manager for Continuous Service Improvement identified that the Customer Service Officers had stopped using this function because data quality was initially problematic.
The community care operations project team subsequently engaged in a data quality improvement initiative. The team had to encourage Customer Service Officers to return to this function once the data quality issue had been addressed. This assessment contains a record of the problems clients need addressed by community aged care services.
It constitutes the basis from which Customer Service Officers perform their initial phone assessment and complete the Intake Priority Form, which supports them to assign a score and a service waitlist position to prospective clients. It also led to additional work for the Customer Service Officers due to a restriction in the size of scanned documents that could be attached to client files. In this case the old operating model of faxing or electronically scanning paper-based documents between Medicare, the Australian government department responsible for aged care funding claims, and the aged care service providers was not compatible with the new IT-enabled operational model of Uniting.
The technical issues described above, both to be eventually resolved, had consequences for the workflow of Customer Service Officers, making their tasks more difficult to complete. Such issues are difficult to identify without explicitly accessing the knowledge that key users have about the system. All staff at Uniting acknowledged the value of information exchange at the frontline of community care. The Service Manager at the centralised service centre additionally pointed out that some of the information exchange occurring at the frontline of care was not explicitly described in Uniting workflow descriptions or official training documents as dictated by their community care systems program plan.
This case study described how barriers to information exchange processes were identified during the implementation of large scale information and communication technology and their implications for the workflows of frontline staff. The key findings of this study are summarised in Table 1 , and are likely to be relevant to many aged care provider organisations grappling with the role of information and communication technology in achieving integrated models of care.
The findings of the current study indicate that evaluation beyond the implementation of information and communication technology itself is necessary to identify unexpected barriers between information and communication technology design and work processes. As has been demonstrated [ 38 ] work as performed is often quite different from work as imagined [ 39 , 40 ].
There are large benefits to organisations who transform the implicit knowledge of frontline information and communication technology users into explicit knowledge that is integrated into service provision practices and organisational policy [ 41 ]. This further corresponds with the research on enterprise architecture. The intent of enterprise architecture is to identify the key technology, data, and system components that must be shared across multiple parts of the organisation [ 42 ].
Enterprise architecture can be considered akin to the functional integration component of the Rainbow Model of Integrated Care using information and communication technology. The organisation identified a need to integrate the information on client demographic data, care plans, and rostering to increase the availability of information across geographically dispersed professionals. The benefits of information and communication technology can take time to emerge. In case studies with eleven organisations working in a variety of industries, Ross and Westerman [ 43 ] identified that some of these organisations reported an initial struggle before the benefits of the new information and communication technology solution became apparent.
While this outsourcing is not the same as Uniting outsourcing the development of their community care management system to a technology vendor, the key finding remains the same. Ross and Westerman further found that within each studied organisation, although they experienced difficulties adjusting to an information and communication technology outsourcing model initially, all eleven had experienced benefits by the end of the study. As is the situation with Uniting, moving from an environment of departmental siloes, in which a different technological structure is present in each department, to more standardised technologies and data requirements, needed organisational learning, which takes time [ 43 ].
Careful research and an understanding of their business before implementing information and communication technology enabled Uniting to achieve immediate benefits. Further benefits will likely evolve over time. Even though this standardised form was introduced, individual work groups were still using local rules to enter data [ 44 ], which manifested in non-standardised data entry and had subsequent impacts on the ability of Customer Service Officers to deliver services as expected to clients.
Uniting are currently working to address these data entry inconsistencies through a continuous quality improvement initiative. In contrast to clinical perspectives on healthcare work, information and communication technology perspectives view work as discrete tasks for individuals that can be represented as pre-fixed workflows [ 22 ].
By imposing this pre-fixed workflow structure, additional burdens on healthcare personnel have been observed in hospitals, home care for frail elderly adults, and the care of patients with stroke [ 38 ]. Being responsive to the feedback of frontline staff should result in improvements to the information and communication technology assets that better match the work processes in each setting.
Uniting have identified and addressed these limitations to the extent they are capable. These findings highlight the importance of designing information and communication technology solutions that support work as it is actually performed by frontline staff, and the value to service provider organisations of explicating these work processes. This case study has also demonstrated that considering the needs and requirements of frontline staff using information and communication technology reveals important information that influences the ability of information and communication technology to support integrated models of care.
By identifying that the automatic search function was not working due to inconsistencies in data entry, Uniting could improve data quality so that this function was available to frontline staff.
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Information exchange is a key component of care coordination [ 46 ] and subsequent safety and quality of care [ 47 ]. Inspecting the information exchange processes around information and communication technology systems provides valuable information about possible barriers that have the potential to disrupt workflow and hinder the provision of quality care services to aged clients.
Internationally, aged care organisations are under increasing pressure to respond to a demanding and changing aged care landscape in flexible ways. Enterprise architecture and enterprise architecture maturity, which is defined by Bradley et al. Leveraging such information technology resources by evolving enterprise architecture maturity has the potential to provide organisations in the community aged care sector with the capability to respond and adapt to an increasingly competitive environment [ 48 , 49 , 50 ]. One of the key stages of enterprise architecture maturity development is the ability to standardise technology to integrate systems and enhance data sharing.
By collecting information in one place that can be accessed by all relevant staff, increased communication was achieved between Care Workers, Case Managers, and Customer Service Officers.
Data sharing and integrity issues were easily identified and resolved, for example standardised data entry across geographic regions of the organisation. The increased visibility of data and the information exchange occurring around it allowed Uniting to increase their information technology efficiency [ 42 ]. These gains in efficiency will allow Uniting to enhance the provision of services to clients. Information and communication technology more generally has the potential to integrate client records and render them fully accessible to multiple users in different geographic areas.
These functions support organisational agility by improving communication and the tracking of service provision [ 51 ]. Community aged care services are information sensitive activities that exchange vast amounts of data across a large array of services, health care providers, and institutions [ 52 ]. The Organisation for Economic and Cooperation and Development has identified the availability and exchange of quality data as a major challenge faced by the sector [ 53 ].
This case study has addressed how service provider organisations can adjust their operational model so that the maximum benefit from information and communication technology implementation can be realised. A close examination of the changes to work processes that are influenced by the introduction of information and communication technology will likely assist organisations to address the barriers to providing efficient and effective care, and therefore develop increasing levels of enterprise architecture maturity to support such functions.
Published literature describing how aged care organisations adjust their operational models to capitalise on the benefits of information and communication technology to support the information exchange processes at the frontline of community aged care is sparse and, to our knowledge, the account we present in this paper is one of the first to address this subject. By exploring the experience of Uniting, we identified key lessons about information and communication technology and its support of integrated care while it was being implemented in a community aged care service provider organisation.
The results emphasise the role of the frontline users in informing the design of an effective information and communication technology system. Implementation of information and communication technology in community aged care settings more generally should consider the context, particularly the workflow of frontline care staff. The data quality issues preventing Customer Service Officers from automatically searching the database for appropriate Care Workers would not have come to light without asking them directly. It is unlikely that merely implementing an information and communication technology system as purchased will be enough to achieve the expected cost effectiveness and care efficiency benefits [ 54 , 55 ].
Enterprise architecture maturity approaches state that such effectiveness and efficiency benefits should not be expected until alignment between work processes and information and communication technology systems has been achieved. Any benefits from information and communication technology will take time to emerge, after multiple rounds of evaluation. Ultimately, continuing to develop the capability of information and communication technology will result in aged care organisations that have achieved functional integration, and are able to provide all the advantages of integrated care to older people living at home under their care.
Only one organisation was studied in this research, which limits the generalisability of our findings to other community aged care providers. The individuals chosen to participate in this study were primarily from the information technology side of the operational model implementation at Uniting, however other information and communication technology developed for community aged care settings might have a different group of key personnel with different relationships and needs.
Further, two of the authors were from Uniting, introducing the potential for conflicts of interest in the reporting of results. These conflicts are unlikely to have affected the results, given that the external research team was responsible for all data collection, analysis, and reporting of results. Despite the limitations, the findings reported in this case study provide valuable insights into the ways in which information and communication technology shapes information exchange processes. These insights can assist in informing future efforts in supporting integrated, quality, and safe care for aged care clients.
A major obstacle to the uptake of information and communication technology in community aged care has been a limited understanding of the unique and complex needs of the sector, in particular the workflows and processes that might influence information and communication technology design and success in this sector [ 30 ]. We have contributed evidence to this area by describing the information exchange processes that were designed to support a centralised community care management system. Investigating the system during its implementation in the organisation highlighted the importance of understanding and incorporating the perspectives of multiple groups.
Despite the careful planning that was invested into a new integrated care model at Uniting, there remained barriers to information exchange that were only identified after the system had been implemented. The key lessons for other service provider organisations attempting to implement functional integration with information and communication technology are that the benefits take time and multiple rounds of evaluation to emerge, and are unlikely to emerge without considering and explicitly modelling the work knowledge and experiences of frontline staff providing care.
Information and communication technology appears to support functional integration by enhancing information exchange and collaboration between professionals providing care. We would like to thank all of the staff at Uniting who participated in this study. Australian Institute of Health and Welfare Canberra: Australian Institute of Health and Welfare. Productivity Commission Caring for Older Australians: Overview.
Canberra: Australian Government Productivity Commission. A descriptive analysis of incidents reported by community aged care workers. Organizational effects of information and communication technology ICT in elderly homecare: a case study. Case managed community aged care: what is the evidence for effects on service use and costs?. Department of Social Services Home care packages. Aged and Community Services Australia Kodner, DL and Spreeuwenberg, C Integrated care: meaning, logic, applications, and implications — a discussion paper.
International Journal of Integrated Care 2: e Towards a taxonomy for integrated care: A mixed-methods study. Towards an international taxonomy of integrated primary care: a Delphi consensus approach. BMC Family Practice Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.
International Journal of Integrated Care e Beland, F and Hollander, MJ Integrated models of care delivery for the frail elderly: international perspectives. ICT use and productivity: a synthesis from studies of Australian firms.
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Australian Government, pp. Department of Communications Information Technology and the Arts These trends bolster the argument made by leading management thinkers that the manufacturing, service, and information sectors will be based on knowledge in the future, and that business organizations will evolve into knowledge creators in many ways. Drucker suggests that one of the most important challenges for every organization in the knowledge society is to build systematic practices for managing a self-transformation.
This paper explores how systematic practices in the use of information technologies are enabling organizations to use knowledge to improve their environ mental performance. The availability of a wide range of timely, relevant information plays an important role in environmental decision making. In managing and designing for the environment, information needs to run the gamut from the simple e. Effective decision making depends on the appropriate data, information, and knowledge being brought to bear on a problem.
However, each of these inputs has a different role in supporting the decision-making process. Recognizing the distinctions between data, information, and knowledge—not always an easy task—is crucial to developing management approaches that leverage their relative values.
The fictional scenario depicted in Box 1 illustrates these distinctions: Data are obtained by observing and documenting facts; information is obtained by analyzing and processing data; and knowledge requires cognition, experience, and understanding. This simplistic hierarchy is shown in Figure 1. The examples of environmental data, information, and knowledge shown in Box 2 illustrate some of the difficulties associated with managing information. Jane Q. She starts by collecting emissions and operating data for the process— an important task.
She analyzes the information and learns what is being emitted and how efficient the process is. She then talks with the people who directly manage the process to hear their insights. She also reviews descriptions of previous attempts to improve the environmental performance of the process.
She contacts colleagues within the company and other professionals she knows who deal with similar processes. She develops innovative solutions. Her immediate supervisor now fears that Jane may be in line for his job. Because information is codifiable e. Knowledge sharing, on the other hand, requires contextual understanding i. Improvements in capturing and managing knowledge in the environmental sphere represent an unexplored opportunity in making improvements in business performance.
Although information management practices in many organizations have a long history and are evolving rapidly, knowledge management practices are somewhat less developed. For example,. Current knowledge transfer is haphazard in most instances, and there are few tools to support it. Knowledge within organizations is scattered, and effective collaboration and knowledge sharing occur inconsistently.
Institutional memory is short. Very little knowledge is captured and retained for future use. As a result, the same problems are addressed repeatedly by different individuals. In some situations, not being encumbered by history can bring fresh approaches, but in most situations, learning from past experience can be beneficial. In the case of environmental improvement, vast amounts of information and knowledge have been generated, and many lessons have been learned from successes and failures in addressing environmental concerns.
Learning has not been lost—it can be found in best-practice manuals and textbooks, on the Internet, in anecdotes and conference proceedings, and in the memories of people who have worked on the issues. Given the rapid advances in information technology, the key is to more effectively manage and use this information and knowledge. The opportunities to improve and apply knowledge management are many, and they cross traditional organizational boundaries.
Such opportunities may exist.
What Is Knowledge Management, and Why Is It Important?
The objectives and approaches are different in each instance, and certain components of information and knowledge may cut across the four areas described. In many instances, broad multifunctional teams are called upon to use various knowledge-sharing tools for work related to compliance, product design, production operations, marketing, response to regulatory initiatives, etc.
Figure 3 illustrates techniques that may be used to gather and share knowledge at various stages of product development. Figure 4 shows examples of tools used to support information sharing among various manufacturing functions and the types of questions or concerns that may lead to knowledge sharing across work functions.
The tools used to support knowledge management should be designed to meet the varied objectives and diverse backgrounds of team participants who may perform various functions throughout the firm. The tools must be able to capture and translate knowledge derived from projects and other activities and make it available to others within the organization for use in their activities.
Today, many firms engaged in the production cycle are more likely to add value to complex production functions by providing services—such as better design, marketing, and distribution capabilities all information and knowledge value-added activities —rather than by actually making products.
Actual manufacturing is more likely to be accomplished through complex and diverse supplier chains that span the globe. Recent advances in transportation and information technologies have made this model the norm of production functions. To meet production goals, companies have to leverage these techniques, making the complex web of upstream supplier-chain activities operate as one seamless unit.
Two other classes of participants are also part of the upstream process: users and customers, who, through their purchasing decisions and patterns, which often are monitored, can help to fine-tune production runs or product requirements. The wide array of stakeholders upstream in the production function makes the transfer of knowledge daunting.
Successful management of this process provides numerous opportunities to identify and exercise options for improving performance, particularly environmental efficiencies. Participants in the process and potential applications of supplier-chain knowledge sharing are shown in Box 3. Use of emerging applications of electronic data interchange standards to transfer data more seamlessly between organizations. At each stage of the product life cycle, stakeholders may exchange knowledge on how to more effectively use, handle, dispose of, or remanufacture a product or material.
Effective knowledge transfer along the supply chain can lead to changes in the material composition, in the product design to enable more effective remanufacture, and in the packaging to reduce waste. Figure 5 shows the tools used to support information sharing among the supply-chain players and the types of questions or concerns that may lead to knowledge sharing across functions. Information technology is likely to play an increasingly important role as an enabler of knowledge management; of more effective communication; and of collaboration across organizational lines, borders, and time zones.
Downstream factors in complex production operations take on greater significance when services—as distinguished from manufacturing, natural resource industries, and agriculture—are factored into the discussion of knowledge management. Accounting for 60 percent of output and employment U. Department of Commerce, , industries in the service sector provide fundamental economic and societal functions such as transportation, banking and finance, health care, public utilities, retail, wholesale, education, and entertainment.
The companies in this sector e. Because companies in this sector also interact with a large consumer base, they are a source of knowledge about consumer preferences downstream in the production-consumption system, and they can play a critical role in conveying environmental information to consumers. The upstream leverage that service firms have on manufacturers is quite evident. As purchasing agents for millions of consumers, these companies exert tremendous leverage over their suppliers by creating markets for environmental improvement.
Their downstream influence is yet to be tapped fully. These service firms, to be successful, must be very close to their consumers, and several companies in this sector provide their consumers with environmental information. Firms that provide this sort of consumer education also provide early insights into consumer tastes, preferences, and regional buying habits. Many firms in the service sector, and indeed most industrial operations, are also providing environmental education and information about their practices via the World Wide Web. Knowledge sharing including validation of claims is an untapped information and knowledge management challenge that involves collaborating beyond the firm with educators, environmental groups, risk communicators, consumer advocates, graphic designers, and information organizers.
Box 4 shows potential participants in knowledge sharing in downstream production activities. Figure 6 shows tools used to support information sharing among downstream players and the types of questions or concerns that may lead to knowledge sharing across functions. Information management systems cannot solve these concerns but they can facilitate collaborative efforts for a wide range of objectives. Figure 7 shows examples of questions that may be addressed by an industry group or consortium.
Technology development and diffusion. Consumer information databases containing environmentally related product and service information. Educational and awareness-building materials e. Best-practice knowledge databases and discussion forums—exchange information between downstream service providers, government, and NGOs. Public discussion forums—exchange information between consumers, government, companies, and others. Their collaboration brought other companies in the electronics industry together to work on sharing information about alternative technologies.
The group also developed an electronic system to share the information they generated. Collaboration among related companies or competitors in the same industry is not rare, and it can fundamentally change the way a business operates. Such collaborations often occur through industry groups and consortia that are intermediary agents in sharing knowledge.
Technical assistance. At the state level, information exchange is critical to enhancing environmental improvement in small and medium-size companies. This information is often garnered with the assistance of universities, environmental groups, and others. Partnerships for innovations in environmental management and design. Regional economic development. Regional planning efforts often blend economic and environmental concerns to arrive at a consensus.
They also can entail an assessment of regional environmental performance. Collaborations based on these issues involve industry, government, academia, and public-interest groups. Fulfilling research agendas. Whether the issues are global e. Figure 8 illustrates the links among various stakeholders and the potential collaborations that could address specific functional needs. There are many technologies that support knowledge management. Examples of common information technology tools that are used to manage environmental knowledge include:.
Data management. Relational database management systems and their associated data management tools provide the ability to store, extract, and analyze large quantities of data arranged in a tabular format. Document management systems. These systems are used to store text, images, and other types of electronic documents so that they can be more easily searched and retrieved.
This provides the ability to create a common repository of documents that is widely accessible and not limited to one location. Groupware and collaborative applications. These technologies can help users to work collaboratively and exchange numerous forms of data, information, and knowledge. Networking, intranets, extranets, and the Internet. This is a broad set of software and hardware technologies that allows computers to connect and share information. The most widely known applications for communications are e-mail and Web browsers e. Information retrieval. Data miners, intelligent agents, spiders, gophers, and other tools help to retrieve useful tidbits from ever-growing repositories of information.
From Web search engines to complex classification systems, these tools help us identify the most relevant data, information, and knowledge for a range of needs. These technologies are key enablers, but their successful use depends on their ability to support the framework and culture within an organization. To implement these technologies successfully, it is important to know the roles of different organizational groups, how work is performed, and how information flows between groups.
The technologies used to manage environmental knowledge are only as good as the organizational structure that supports the work processes through clear roles and responsibilities. The policies, procedures, and guidelines that identify the goals, expectations, and suggested practices within an organization must be clearly articulated and known; only then can the systems and tools that support the framework and culture be successful.
As Heptinstall this volume shows, implementing a successful environmental information system requires an understanding of the following steps:. Setting goals.
Determining the environmental goals of a company is the first step in defining the information that needs to be managed. Information management goals for environmental regulatory compliance are going to be different than those for business practices for sustainable development. Defining processes. Defining the processes used to generate, retrieve, use, and share information can help to determine the needed infrastructure.
Installing the infrastructure. Computers and communications technologies will be the largest and most expensive portion of the infrastructure. However, there are also noninformation technology aspects to be considered, such as human networks and knowledge-transfer processes. Motivating and providing rewards. Attempts to improve information sharing are doomed to failure unless people are encouraged to share. Policies and cultural environments that reward and encourage information hoarding should be revisited and replaced with compensation contingent on knowledge-sharing activities.
Measuring the results. Measuring results is a difficult task. It is important to attach milestones and feedback mechanisms to information management projects and to document anecdotal evidence that goals are being met. It is not unusual to have even the best-laid plans run into difficulty along the way. In the case of implementing an effective information and knowledge management system, difficulties may arise in relation to the following factors:.
Work process changes. Tools to support knowledge management can require substantial changes to the way a person behaves and performs work. Whether it necessitates communication via e-mail rather than by phone, or referring to electronic documents rather than printed ones, work process changes can be a substantial barrier to success. Tools need to be developed that are compatible with existing, effective work processes.
Proactive management of change will be required to improve inefficient work processes and to overcome the traditional resistance to new technologies. Measuring the effects of knowledge management. The inherent value of knowledge management is difficult to quantify or demonstrate and therefore is often ignored. Although the valuation of more traditional corporate assets such as equipment and infrastructure is well developed, it is much more difficult to quantify the value of knowledge assets, and accordingly, to quantify the benefits of preserving them.
In building knowledge systems, simply collecting information is insufficient; one has to be smart about how to apply the information as well.