Choosing the Base Model and the Model Constructs

The model by Kulkarni et al. (2007) is the only KMS success model validated in prior research that included both organisational and system factors. It is based on the DeLone and McLean IS success model that has been validated in multiple contexts and found to be flexible and robust (see section 2.3.1 for an introduction of the DeLone and McLean IS success model).

Building on the basis of existing models results in the creation of well-developed research streams allowing the establishment of the nomological validity of constructs, as constructs and relationships between constructs are tested in a broad variety of settings (Gefen, Straub, & Boudreau, 2000). Therefore, reusing existing research models (when such models are available) results in a greater accumulation of knowledge within the research community than creating entirely new models. Even though some of the constructs of the model by Kulkarni et al. (2007) were operationalised in ways that are somewhat problematic (see the discussion in section 2.5), a model of KMS success in healthcare was

built on its base, adjusting it to fit the target context of healthcare and improving its overall structure.

The rest of this section briefly discusses the selection of constructs to include in the model. The individual constructs are then discussed in detail in sections 3.3 (covering the outcome variables) and in section 3.4 (covering organisational and system success factors).

Kulkarni et al. (2007) interpreted net benefits—the ultimate outcome of KMS success—as knowledge use. As highlighted in the section discussing knowledge gaps (section 2.6), it is desirable to distinguish knowledge seeking from knowledge sharing. Therefore, in the spirit of the KMS success model by Wu and Wang (2006), net benefits were interpreted as KMS use, but, unlike Wu and Wang, KMS use for sharing and KMS use for seeking were distinguished as separate dimensions.

To maintain research continuity and to benefit from the extensive validation of the DeLone and McLean IS success model (see section 2.3.1 and Figure 2-4) in prior research, all constructs were retained from the Kulkarni et al. (2007) model that matched the constructs of the DeLone and McLean IS success model. Kulkarni et al. was followed in replacing the system use construct in the DeLone and McLean IS success model with perceived usefulness, but interpreted perceived usefulness as perceived usefulness of KMS in particular, rather than of knowledge sharing in general, which was consistent with the model by Wu and Wang (2006). The problems associated with replacing the concept of system use in the DeLone and McLean IS success model by perceived usefulness of knowledge sharing in general are discussed in section 2.5.

The factors affecting knowledge sharing and knowledge seeking (or KMS success in general) consistently supported by prior research (listed in sections 2.4.2 and 2.4.3) were then considered, and compared them with the system and organisational factors suggested by the model by Kulkarni et al. (2007). When deciding whether or not to include a factor in the model, I took into account the results in Ryu et al. (2003)—an empirical study on knowledge sharing conducted in healthcare, as well as the opinions stated in three conceptual articles devoted to knowledge management in healthcare: Desouza (2002), Koumpouros, Nicolisi and Martinez-Selles (2006), and Wickramasinghe et al. (2007). These articles presented opinions of qualified individuals working in healthcare based on

their experience in the field and on their knowledge of KM and KMS literature but did not report collection or analysis of empirical data.

The factors considered were incentive / reward, leadership, subjective norm, culture of sharing, security, reciprocity, usefulness, and self-efficacy.

Incentive was included in Kulkarni et al.’s (2007) model and has been cited as an important factor in healthcare (Desouza, 2002). The incentive factor was retained and was judged to be equivalent to reward. Leadership was included in the Kulkarni et al.’s model and has been cited as an important factor in healthcare (Desouza, 2002). The leadership factor was included. As argued in section 2.5, leadership and incentive factors can be viewed as corresponding to transformational and transactional leadership introduced in section 2.3.3.

Subjective norm is similar in content to co-worker and supervisor constructs in the Kulkarni et al.’s (2007) model (as discussed in section 2.5), and it has been found to affect knowledge sharing among physicians (Ryu et al. 2003). As discussed in section 2.5, the constructs of co-worker and supervisor were found to be somewhat problematic. Therefore, subjective norm (a well-known construct with an established nomological validity) was included instead of co-worker and supervisor.

Culture of sharing has been cited as an important factor in healthcare (Desouza, 2002; Wickramasinghe et al., 2007). Culture of sharing is related to subjective norm, but is not the same (see section 2.3.2 for a discussion of these constructs from the theory perspective). Culture of sharing was included as a separate factor, distinct from subjective norm.

Trust is related to security and has been consistently cited as an important factor in healthcare (Desouza, 2002; Koumpouros et al., 2006; Wickramasinghe et al., 2007). Therefore, security was included as a separate factor. In this study, perceived security was viewed from the perspective of environmental and behavioural uncertainty (introduced in section 2.3.4).

Reciprocity is similar to subjective norm and thus was judged to fall under subjective norm and was not included as a separate factor. Usefulness is similar to knowledge content quality in Kulkarni et al.’s (2007) model, and therefore was not included as a separate

factor. Self-efficacy was not covered in the Kulkarni et al.’s (2007) model. Self-efficacy was not identified in the literature as a factor relevant to healthcare. Indeed, it is difficult to see why it would be more relevant in healthcare than in other contexts. Even though in terms of the success of KMS in generic contexts self-efficacy may be relevant, I did not include it in this study to keep the scope and the focus of the study under control.

Thus, the constructs included in the model are as follows. KMS use for sharing and KMS use for retrieval were used as the outcome variables of KMS success (representing net benefits in the DeLone and McLean IS success model). KMS use for sharing and KMS use for retrieval are discussed in detail in section 3.3. Knowledge content quality, KMS quality, perceived usefulness, user satisfaction, and perceived security were included as system factors (discussed in detail in section 3.4.1). Incentive, leadership, subjective norm, and culture of sharing were included as organisational factors (discussed in detail in section 3.4.2). In sections 3.4.1 and 3.4.2, devoted to system and organisational factors, respectively, I examine the factors one by one to reconfirm the need for their inclusion in the model. The cause-effect relationships between the constructs—the hypotheses tested in this study—are introduced and justified in section 3.5.