Contribution of Knowledge Management to the Optimization of Healthcare Settings’ Performance in Cameroon Martin Tchoukoua Jean Robert Kala Kamdjoug FSSG, GRIAGES, Université Catholique d’Afrique FSSG, GRIAGES, Université Centrale Yaoundé, Cameroon Catholique d’Afrique Central Yaoundé, Cameroon tchoukoua.martin@gmail.com jrkala@gmail.com I. INTRODUCTION II. THEORETICAL DEVELOPMENT Public health issues are priority issues for any government. Druker [4] argued that knowledge is "the only significant According to WHO, health is a complete state of mental, resource" in business today. The resource-based enterprise physical and social well-being and not just the absence of vision has acquired a new dimension in the theory of disease or infirmity. In other words, a person with a balanced knowledge. It can be viewed as a strategic asset of an combination of mental, physical and social conditions is organization that must to be managed [5]. Thus, based on the considered healthy. One of the core challenges of the current literature around the theory of knowledge, we defined a modern-day environment is the quality or the shortage of structural model made of five concepts for this research: human resources. More than ever, it has stood at the centre of technology capacity, organizational culture, knowledge concerns in all countries, albeit with some acuteness in transfer, process innovation, and organizational performance. developing countries. However, while healthcare centres and hospitals around the world have striving to have performant A. TECHNOLOGY CAPABILITY human resources, they are expected to do the same in terms of knowledge management and sharing. The sharing of Researchers such as Davenport and Prusak [6], Gupta and experiences plays a key role in optimizing the performance of Govindarajan [7] found that computing is a key element for health practitioners. And this inevitably entails a structured knowledge creation. Indeed, IT is extensively used to connect management of knowledge generated by the daily practice of people with reusable coded knowledge, and it facilitates the various health structures. conversations geared toward creating new knowledge [8]. In this regard, Mills and Smith [9] argue that information Performance remains one of the overarching goals of technology enables not only the incorporation of information income-generating enterprises, including healthcare and knowledge into a company, but also the creation, transfer, institutions. Given the challenges faced by health information storage and retention of the company's knowledge asset. A systems, maximizing organizational performance is still an well-developed technology integrates fragmented streams of ideal. In the health sector like in other industries, identifying, knowledge, which has the potential of removing obstacles to accumulating and encoding knowledge are efforts that should communication between the different departments of the be followed by a sound knowledge management for informed organization. Therefore, we have formulated the following and improved clinical decision-making. hypothesis: The aim of this article is to investigate the role of effective H1: Technological capacity positively influences the knowledge management in selected hospital structures of transfer of knowledge within an healthcare setting. Yaoundé and even in other areas of Cameroon. To accomplish this goal, we will try to answer the following big question: Can B. ORGANISATIONAL CULTURE we achieve an optimal level of performance in a hospital structure following a successful practice of knowledge Culture is defined as the system of beliefs, values, customs, management? To answer this question, our research model, behaviours and artefacts that are used by stakeholders of a which is based on the models by Darroch[1], Slavković and humanity to face their world and interact, and which are al.[2] and the model of Theriou and al.[3], was defined and transmitted from generation to generation through learning. tested. Only constructs were used in our study, but they [10]. However, the biggest obstacle to knowledge management adequately emphasized the link between the effective practice may be the organizational culture [11]. of knowledge management and organizational performance. Generally, culture enhances knowledge, helps its creation, sharing and application while promoting an open climate for the free flow of ideas [12]. As a result, we set forth the following assumption: Copyright © 2019 for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0) IREHI 2018 : 2nd IEEE International Rural and Elderly Health Informatics Conference H2: The better the organizational culture within a III. METHODOLOGY healthcare setting, the more its staff will be able to transfer To analyse the aforementioned hypotheses, we have opted knowledge. for a research methodology based on a hypothetico-deductive approach whose process follows a number of steps, including C. KNOWLEDGE TRANSFER the elaboration of the questionnaire using a seven-level Likert Researchers and academics have not yet reached a scale, and data collection and analysis (with a choice of the consensus on the definition of knowledge transfer, as this sample size, the administration of the questionnaire, and the concept is being interpreted from different perspectives, collection and processing of data). Regarding the questionnaire especially from the perspective of the interaction of knowledge development phase and the choice of the sample size, it should [13]. However, different members of a group with different be noted that our questionnaire had exactly 78 questions on all ideas and experience create new knowledge by communicating the different items of research models. The questionnaire was and sharing. So knowledge transfer can be viewed as the then adapted to our research environment, and pre-test was dissemination of individual knowledge in an organization [14]. carried out by 11 people (10 students from the Management Gloet and Terziovski [15] believe that human resources can be and Information System (MSI) at the Catholic University of considered a strategic lever to create a competitive advantage Central Africa, and 1 medical staff.) In addition, the software through the value of knowledge process. It is through the use of GPower3 and the method of calculation of Hair and Al[21] knowledge that the assimilated knowledge can be changed allowed us to have a clear idea about the minimum sample size from a potential capacity into a achieved capacity that affects to be considered in our work. organizational performance. [9]. Considering such findings, we The administration of the questionnaire was done using a make the following assumptions: door-to-door approach and paper forms. A pilot phase H3: Knowledge transfer within a healthcare organization consisting in analyzing remarks from 30 medical respondents reinforces the process innovation of knowledge. had been conducted beforehand in order to ensure the reliability of our constructs and the stability of our research H4: Knowledge transfer has a positive influence on model. The 400 administered questionnaires yielded only 131 organizational performance in health care. usable observations, which were collected and recorded on an Excel file to initiate the data processing process. The data D. PROCESS INNOVATION processing was conducted by means of ADANCO, version 2.0.1, which is a software application for analysing structural Process innovations are those that occur in the technical equation models based on the PLS partial least squares method parts of an organization and are directly linked to the main [22]. It should be noted that at the end of this phase of analysis work activity of that organization. They may be a work in and data processing, we did not record any missing data. progress, or the introduction of new elements into the production or service operations of an organization [16]. IV. DATA ANALYSIS AND RESULTS The demographic profile of our 131 respondents is shown in Table 1 below: TABLE I. DEMOGRAPHIC CHARACTERISTICS OF THE POPULATION Profile Description Number Frequency Gender M 64 48,85% F 67 51.15% Age Less than 25 years 14 10,68% 26-30 38 29,01% 31-40 47 35,87% Fig. 1. Research model Organizational performance is about how every groups is 41-50 26 19,84% organized to reach its targets and how it manages to achieve Over 50 years 6 4,60% them [17]. Literatures reveal that organizational innovation is important for better performance [18]. For Calantone and Work Less than 5 years 55 41,98% al.[19], innovation capacity is the most important determinant experience of a company's performance.[18]. So innovation can cause 5-10 45 34,35% faster organizational performance in all the areas it agrees with 11-15 20 15,26% [20]. As a result, we formulate the following hypothesis: H5: The higher the process innovation capacity of a 16-20 6 04,58% healthcare structure, the better its performance. Over 20 years 5 03,83% We note from Table 1 above that our 131 respondents were Organizati made up of 64 men and 67 women and that most of them were Technolo Process Knowled Organization onal Construct gy Innovati ge aged between 31 and 40. In addition, about 65.08% of this al Culture Performan Capacity on Transfer population had at least 5 years of work experience. ce Culture With regard to the validity of our research hypotheses, the stability of our research model and the quality of our Process 0,7773 0,8140 Innovation constructs, we would like to recall some theoretical standards. The elimination of overt variables is not a game of chance. Knowledge 0,5373 0,8134 0,7210 Hair and al. [23] point out that overt variables with an outer Transfer loading of less than 0.4 should be removed, and that those with Organizational 0,6693 0,8253 0,8326 0,7810 an outer loading value between 0.4 and 0.7 should be retained Performance only if they represent a latent variable with an AVE greater Structural Model. The use of the bootstrapping method than 0.50 and if all manifest variables with an outer loading enabled us to test the significance of both the relationship greater than 0.7 are retained. Moreover, reliability of the between model constructions (through the interpretation of t- constructs and the stability of the research model are being statistics) and the correlation between these constructs (by confirmed by the quality of our items, which depends on the looking deeply at the values of the correlation coefficient). The values of both the composite reliability and Crombach alpha t-statistic must be greater than 1.96 to express a being theoretically greater than 0.7 [23]. significance[24]. Table 4 below summarizes these values: As indicated in Table 2, the Cronbach’s alpha values and TABLE IV. STRUCTURAL MODEL TESTING HYPOTHESIS USING the Composite Reliability values are above the 0.7 threshold, BOOSTRAPPING. thereby suggesting that our constructs are reliable and have Original Standard P- good internal consistency. In addition, the Average Variance Hypothesis T-value coefficient error value Extracted (AVE) values are greater than the threshold of 0.5, Technology Capacity which is evidence of a convergent validity for the measurement 0,03 ->Knowledge 0,1379 0,0670 2,0588* indicators of each construct. 96 Transfer TABLE II. CONSTRUCT RELIABILITY AND VALIDITY Organisational 0,00 Culture - 0,5196 0,0808 6,4295*** 00 Construct Cronbach’s Composite Average >Knowledge Transfer alpha Reliability Variance Process Innovation - (CR) Extracted(AVE) 0,00 >Organisational 0,4185 0,0725 5,7756*** 00 Performance Technology 0,8910 0,9138 0,6034 Capacity Knowledge Transfer - 0,00 0,4474 0,0725 6,1686*** >Process Innovation 00 Organisational 0,8884 0,9130 0,6011 Culture Knowledge Transfer - 10,2258** 0,00 >Organisational 0,393 0,0568 Knowledge * 00 0,8060 0,8732 0,6328 Performance Transfer ***P < 0.001; **P < 0.01; *P < 0.05; Process Innovation 0,7399 0,8531 0,6616 Table 4 above shows results obtained by means the version 2.01 of ADANCO boostrapping. It clearly appears that all our Organisational research hypotheses (H1, H2, H3, H4, and H5) are verified and 0,8833 0,9072 0,5508 Performance supported. Table 5 below shows the various results from the Based on Table 3, we can conclude that there is good testing of hypotheses. discriminant validity of our constructs since all HTMT values TABLE V. HYPOTHESIS TESTING RESULTS are well below the threshold of 0.85 or 0.9. So our assumptions consist of constructs that are distinct from each other. Indeed, Hypothesis P-value Decision the HTMT ratio is an estimate of the correlation between the H1 : Technology Capacity -> Verified constructs, its measurement allows us to see whether there is a 0,0396* Knowledge Transfer hypothesis lack of discriminant validity or not; or more specifically, to know if the constructs are distinct from each other.[24]. H2 : Organisational Culture Verified 0,0000*** TABLE III. HETEROTRAIT-MONOTRAIT RATIO (HTMT) -> Knowledge Transfer hypothesis Organizati H3 : Knowledge Transfer -> Verified Technolo Process Knowled 0,0000*** Organization onal Process Innovation hypothesis Construct gy Innovati ge al Culture Performan Capacity on Transfer ce H4 : Knowledge Transfer -> Verified Technology 0,0000*** Organisational Performance hypothesis Capacity Organisational 0,5835 Hypothesis P-value Decision H5 : Process Innovation - Verified 0,0000*** >Organisational Performance hypothesis ***P < 0.001; **P < 0.01; *P < 0.05; As indicated in this table, the different influences between our constructs are analyzed as follows:  THE INFLUENCE OF TECHNOLOGICAL CAPACITY From the results obtained, following the analysis of the data and those contained in the table above, we observe that for a level of significance equal to 99.9%, the technological capacity does not have a significant influence on the transfer of knowledge. This could mean that managers or leaders of urban Cameroonian health centers or hospitals do not necessarily have to invest heavily in technological capacity for efficient knowledge transfer. This result is also consistent with that Fig. 2. Research model obtained by ADANCO 2.0.1 highlighted by researchers such as N. Theriou, D. Maditinos, It would therefore be wiser for decision-makers to invest and G. Theriou [3], who demonstrated that technological heavily in their ability to develop industry processes as well as capacity plays a minor role in the effectiveness of knowledge for the quality of care provided in their field of competence, for management and does not significantly influence it. highly improved health care performance. This result is in  THE INFLUENCE OF ORGANIZATIONAL CULTURE contradiction with the one obtained by Darroch [25], but Our study shows that organizational culture significantly remains very strong in the literature, including studies by M. influences the transfer of knowledge. This may mean that Slavković and V. Babić [2], N. Theriou, D. Maditinos, and G. governments or hospital officials need to increase investment Theriou [3]. in education and cultural change in this sector. This influence holds true for researchers such as N. Theriou, D. Maditinos, V. CONCLUSION, DISCUSSIONS AND LIMITATIONS and G. Theriou [3], who studied the influence of organizational This work aimed at demonstrating the major impact of culture on the effectiveness of knowledge management and knowledge management through knowledge sharing on the concluded that the organizational culture reinforces and organizational performance of health structures; it appears that encourages knowledge and knowledge creation, sharing, and all the assumptions made have been verified. This indicates application, while promoting an open climate for the free flow how interesting our research model may be in terms of of ideas. contribution to an effective and formal practice of knowledge  THE INFLUENCE OF KNOWLEDGE TRANSFER management in the health structures of Cameroon. Indeed, our study shows that organizational culture significantly influences Our study shows that knowledge transfer significantly knowledge sharing. This may mean that governments or influences organizational performance and has a direct and hospital officials need to increase investment in education and positive effect on innovation. As a result, it could mean that cultural change in this sector. Because this influence remains any improvement on knowledge management processes (such true for researchers like N. Theriou, D. Maditinos, and G. as knowledge transfer) also encourages innovation and implies Theriou [3] who, in studying the influence of organizational that investing in this process in health care could lead to a culture on the effectiveness of knowledge management, have significantly improved organizational performance in the shown that organizational culture enhances knowledge, health sector. This result has been proved by several other encourages its creation, sharing, application and promotes an researchers, including M. Slavković and V. Babić [2], Darroch open climate for the free movement of ideas and knowledge. [25], N. Theriou, D. Maditinos, and G. Theriou [3]. This study shows that knowledge sharing significantly  THE INFLUENCE OF INNOVATION influences organizational performance and has a direct and Based on the results obtained, it is clear that although positive effect on process innovation. This could mean that any innovation may be a partial mediating effect in the relationship improvement in knowledge-sharing processes also encourages between knowledge transfer and organizational performance, it innovation and implies that investing in the development of has a significant influence on organizational performance in the knowledge management in health care can lead to improved public health domain. organizational performance in the health sector. It is clear that process innovation is a partial mediator of the relationship between knowledge sharing and organizational performance, but it significantly influences organizational performance in the public health domain. 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