Knowledge boundaries and boundary spanning

Not all groups within organisations are CoP (Oborn and Dawson, 2010a). Some groups might work together because of an organisational or professional

association; they represent a functional group (Oborn and Dawson, 2010b). Divides between these groups are often referred to as cross-community

boundaries (Hislop, 2013). The collaboration and knowledge mobilisation that occurs between functional groups is known as boundary spanning (Carlile, 2004). It describes how individuals who sit on either side of a theoretical or practical boundary have divergent identities and knowledge that can be bridged by spanning the boundary.

2.4.3.1 Knowledge sharing between functional groups

Carlile (2002) describes the divide between functional groups as a knowledge dimension and suggests that the characteristics of knowledge are important for knowledge mobilisation. In my study, functional groups could be managers and clinicians, or distinct groups of clinicians such as orthopaedic surgeons. They

could even extend to policy-makers and whole hospital organisations. Each one of these groups could have distinct interpretations of what knowledge is.

The identities that people have in the groups or contexts influence the dynamics and interpersonal relationships that develop. Consequently, these impact on the inter-personal knowledge processes (Carlile, 2002). The knowledge processes between different contexts and functional groups are likely to be more complex and challenging to manage compared to those that exist within a CoP. This is because identities, meanings and interpretations are not shared in the same way. Nevertheless, collaboration between individuals and groups is required for organisations such as hospitals to function. We cannot expect entire

organisations to develop as a CoP. To understand knowledge mobilisation in healthcare, it is important to understand how knowledge can be shared across boundaries and how the lack of common knowledge and shared identity shapes knowledge dynamics. The contextual nature of knowledge develops within distinct functions of an organisation because each function has a specific focus, distinctive problems and localised practices that become the norm (Carlile, 2002). This implies that what works for the surgeon may not necessarily work for a finance manager within the same organisation. Collaboration across the distinct functional boundaries, for example to purchase hip replacement

prosthesis constitutes a boundary spanning process. The delivery of healthcare services involves multidisciplinary cross professional collaboration.

The knowledge base of an organisation can, be considered as made up of a variety of localised groups. The difference in the knowledge of these groups could lead to variation in the practice of group members. Groups can have some over-lapping knowledge, but there will be one who potentially possess more specialised and specific knowledge about a topic compared to another (Hislop, 2013). The idea that knowledge can be mobilised using a boundary spanning approach suggests that the fragmented knowledge of the distinct groups could be integrated, to achieve a specified goal.

2.4.3.2 Knowledge processes across boundaries

Members of CoP share a tacit understanding of knowledge processes which makes knowledge sharing easier (Van Den Hooff et al, 2003). When examining functional groups who work across boundaries, knowledge processes are not as straightforward. Individuals working in large hospitals might not necessarily have common knowledge, similar values and shared identity. This can lead to ineffective knowledge mobilisation, as the social relations between individuals who are not members of the same group are less conducive to effective

knowledge sharing (Currie and White, 2012).

There are two key factors that make the process of cross-boundary knowledge sharing challenging for healthcare and particularly for orthopaedic surgery. These are the weak shared sense of identity between groups, and the difference in the accepted and privileged knowledge of each boundary group (Hislop, 2013). The epistemic differences between the groups in my research may also limit knowledge sharing that takes place, for example between managers,

clinicians and administrative staff (Jacobson, 2007). This is because the different knowledge types are based on different assumptions, values and world views about what is true and correct (Jacobson, 2007).

2.4.3.3 Different types of boundaries

The different types of boundary which have to be crossed are also important for knowledge mobilisation and are worthy of investigation. Three distinct

boundary categories have been described in the literature (Carlile, 2004). Syntactic boundaries are presumed to be the easiest to cross because individuals share a common set of ideas and values (Carlile, 2004). This boundary describes knowledge sharing between two surgeons in the same specialty who mobilise knowledge and information together with ease. The second type of boundary is called a semantic boundary. Knowledge sharing here is slightly more

challenging. People on either side of this boundary do not share the same identity or values of practice, and this leads to differences in interpretation and understanding of the same information (Carlile, 2004), e.g., the knowledge contained in a clinical guideline. The most complex boundary is the pragmatic

boundary (Carlile, 2004). This type of boundary is problematic because

individuals have significantly different views and beliefs about knowledge, and also contrasting interpretations of the politics of practice and of how work should be conducted (Currie et al, 2007). Knowledge mobilisation across pragmatic boundaries is not easy to achieve, as both sides are invested in their way of thinking and behaving, and knowledge sharing is restricted (Kimble et al, 2010).

A key factor in all three boundaries described by Carlile (2004) is the ability to work across the boundary through the introduction of a common ground. This could be an object, a specific knowledge artefact or a knowledge broker, e.g., an individual with knowledge and identify across both sides of the boundary. These knowledge objects or brokers can act as a vehicle to help smooth the crossing of boundaries because groups perceive themselves to be equal from both sides (Star and Griesemer, 1989). In this sense, boundaries do not always have to engender the identity and epistemic challenges described earlier, if groups can develop a shared understanding or aim. However, in practice it might be difficult to achieve when common knowledge is absent, for example when evidence- based knowledge is in direct competition with the practice-based knowledge of clinicians.

Knowledge mobilisation is nevertheless necessary for healthcare and is fundamental for the effective use of clinical guidelines in practice. Hence, focusing on understanding and improving the interaction and communication that takes place across knowledge boundaries will be important for my research. Effective knowledge mobilisation implies those involved in healthcare appreciate and are accepting of the differences in perspectives and knowledge which exist in the real world NHS.

2.4.4 Absorptive capacity and the capabilities of healthcare organisations