THE IMPACT OF STRUCTURAL COMPLEXITY ON KNOWLEDGE MANAGEMENT PROCESSES: A
CASE STUDY OF THE FRIENDSHIP OPHTHALMOLOGY HOSPITAL ALGERIA CUBA IN DJELFA
EL IMPACTO DE LA COMPLEJIDAD ESTRUCTURAL EN LOS
PROCESOS DE GESTIÓN DEL CONOCIMIENTO: UN ESTUDIO DE CASO DEL HOSPITAL
OFTALMOLÓGICO DE LA AMISTAD ARGELIA CUBA EN DJELFA
Mokhtar Rabhi I
Ahlam Thamri I
Mohammed Said Djoual
I
Rima Affaf Harizi I
Souaad Ben Messaoud II
I Ziane Achour
University of Djelfa, Djelfa,
Algeria.
✉
rabhi@univ-djelfa.dz, ahlam.tamri@mail.univ-djelfa.dz, s.djoual@mail.univ-djelfa.dz, ra.harizi@univ-djelfa.dz
II University of Djelfa, Djelfa, Algeria.
✉
s.benmessaoud@univ-djelfa.dz,
* Author to address correspondence: rabhi@univ-djelfa.dz
Classification JEL: C42, C51, H75,
DOI: https://doi.org/10.5281/zenodo.1336436
Received: 27/07/2024
Accepted: 14/08/2024
Abstract
The hospital is a complex system that includes several variables, and knowledge represents the most critical input that interacts in order to effectively meet patients' needs. The study sought to empirically test the relationship between structural complexity and its dimensions: horizontal differentiation, spatial differentiation, vertical differentiation and knowledge management processes: acquisition, storage, distribution, and application among a sample of workers at the Friendship Ophthalmology Hospital Algeria Cuba in Djelfa. A questionnaire was designed to collect data from the study sample, and the data was processed and analyzed based on the SPSS 22 and Smart Pls 4 programs. The study yielded results, the most important of which are: There is a significant effect of horizontal and spatial differentiation on Knowledge management processes in the hospital. The study recommends adopting information and communication technology and integrating it into various hospital operations to simplify healthcare practitioners' tasks
Keywords: horizontal differentiation, spatial differentiation, vertical differentiation, knowledge management, hospital.
Resumen
El
hospital es un sistema complejo que incluye varias variables, y el conocimiento
representa el insumo más crítico que interactúa para satisfacer eficazmente las
necesidades de los pacientes. El estudio buscó probar empíricamente la relación
entre la complejidad estructural y sus dimensiones: diferenciación horizontal,
diferenciación espacial, diferenciación vertical y procesos de gestión del
conocimiento: adquisición, almacenamiento, distribución y aplicación entre una
muestra de trabajadores del Hospital Oftalmológico de la Amistad Argelia Cuba
en Djelfa. Se diseñó un cuestionario para recolectar
datos de la muestra de estudio, y los datos fueron procesados y analizados con
base en los programas SPSS 22 y Smart Pls 4. El
estudio arrojó resultados, los más importantes son: Existe un efecto
significativo de la diferenciación horizontal y espacial en los procesos de
gestión del conocimiento en el hospital. El estudio recomienda adoptar
tecnologías de la información y la comunicación e integrarlas en diversas operaciones
hospitalarias para simplificar las tareas de los profesionales sanitarios.
Palabras clave:
diferenciación horizontal, diferenciación espacial, diferenciación vertical,
gestión del conocimiento, hospital.
Introduction
The features of competition in the
world today include health care services as a pivotal dimension to which
priority is given.1 Hospital management constitutes a complex
system, and healthcare quality is considered its most significant outcome. It
is linked to several variables: healthcare service providers, structural
characteristics, healthcare equipment, professional protocols, and Coordination
mechanisms between healthcare professionals and patients.2 On the
other hand, hospitals face the pressures of providing appropriate health care
to many patients and the corresponding limited time resources.3
Therefore, all healthcare systems are required to provide adequate services
based on a timely response to gain the satisfaction of their customers.4
This requires changes in structural relationships and roles to overcome the
difficulties that arise in health care.5 Thus, complexity imposes
itself in the healthcare environment to include the required knowledge behaviours,
mechanisms for translating knowledge into practical practices, and ways to
facilitate its application.6
The concept of structural complexity
Structural complexity measures how functions differ in
aims, task orientation, and autonomy.7 It also concerns how
mechanisms allocate and manage tasks.8 Structural complexity is associated with tasks
that require multiple paths and solutions, differentiated goals, and a volatile
environment.9 Therefore, structural complexity corresponds to tasks
that are challenging to complete because they are unfamiliar and non-routine,
necessitating specialized knowledge and the ability to deal with novel
problems. The complexity is related to an internally uncertain task
environment, and the amount of information at the workplace level needs to be
increased, as it requires participation between co-workers and the formation of
work teams to address it.10
In the classical literature, the structural complexity
is limited to the heterogeneity and lack of interdependence between tasks,
which necessitates the fragmentation and division of administrative
responsibilities and the analysis of administrative tasks to facilitate
coordination between complex tasks.11 Fredrickson( 1986)12 pointed out that structural complexity is represented by
the difficulty of agreeing on goals and the lack of unification and consensus
on how to reach them. Hence, Structural complexity is the performance of
unusual tasks that require cooperation between groups in the organization and
the exchange of information, so organizations were encouraged to participate as
a group work, which is more valuable than individual work in terms of the
ability to understand the issue, define its dimensions, and make a decision on
it.13,14 Structural complexity can be understood as situations where
no individual can handle organizational decisions alone. It also includes jobs
that require mutual adaptation rather than standard rules, standards, and
practices to standardize behaviour.15 In other words, structural
complexity is limited to tasks that require access to specialized training and
experience, division of responsibilities, and empowerment of individuals, as
opposed to simple and routine tasks.16
Forms of structural complexity
Nevertheless, structural complexity is a response and
reaction to the complexity of the organization's internal or external
environment. The internal environment consists of the people, processes, and
technologies that constitute the basic strategy of the organization. The
external environment includes what the organization must respond to regarding
customers, markets, suppliers, and competitors.17 Complexity
includes three forms of differentiation. Horizontal differentiation refers to
the degree of separation between organizational units based on the skills of
individuals and the nature of their tasks that require specialized knowledge.
Thus, the complexity of the organization increases with the increase in the
difference in occupations within the organization. Vertical differentiation
relates to the depth of the organizational structure, which is explained by the
number of hierarchical levels in the organization. Vertical differentiation is
a response to increased horizontal differentiation. In contrast, spatial
differentiation refers to the degree to which an organization's activities, offices,
and staff are dispersed in different locations.18
Hall (1968)19 claimed that differentiation in a job is primarily related
to the variety of attitudes and behaviours of the organization's personnel,
which results in different orientations towards precise goals, diverse
viewpoints, and specific skills. Accordingly, the complexity must be studied
through a multidimensional approach that includes the characteristics and
nature of individuals and decision-making approaches in addition to the
contextual factors of the organization, such as technology, size, and culture.20
Thus, structural complexity is a degree of internal division into parts of the
organization. The indicators used to measure it are the number of general
objectives of the organization, the number of departments and departments in
the organization, the number of hierarchical levels of the organization, and
the degree of dispersion of physical facilities and employees and their
locations.21
In addition, the type of organization differs from the
structural complexity according to the following indicators:
- Increasing the specialization
of work and the accompanying creation of different jobs in the
organization and attempting to create different jobs;
- Raising the volume of
departments results in the division of responsibilities between
departments;
- The control of employee behaviour;
- Decision-making delegation in
the organization.
Characteristics of complex
organizations
As a result, the design of more complex organizations
requires relatively decentralized and less formal structures to increase the
information exchange between the organization's members within the framework of
informal organization spontaneously due to the interaction of individuals among
themselves.22
Some researchers claim that high structural complexity
facilitates innovations.23 Structural complexity also contributes to
the organization's effectiveness through strict supervision of the activities
of subordinates.24 It is associated with the complexity of the
organization's tasks and results in increased training.25 Moreover,
organizations with more complex structures have an increasing rate of
managerial communication between departments and also need a high flow of
information and accurate diagnosis of organizational situations.26,27
Thus, structural complexity requires an integrated system, data from different
sources, resources and procedures for reasonable control in this system, and
the harmony of the organization's internal organization between its various
units and individuals is necessary.28,29 Without a doubt, the design
of structural complexity is characterized by multiple hierarchies to try to
reduce errors at the organizational levels.30
Structural complexity and contextual
factors of the organization
Generally, the degree of variation in structural
complexity between organizations is explained by contextual factors:
technology, size, environment, culture, and strategy. In organizations applying
complex technology, the appropriate structure is the organic structure, and
technology-specific organizational units are developed for work methods to be
compatible with technological changes.31 In the same context, when
the size of the organization increases, it corresponds to an increase in the
number of employees, the diversity of the organization's functions, and the
multiplicity of the locations of the organization's departments, which creates
the difficulty of coordination between them and it is necessary to formalize in
order to program the behaviour of the organization's personnel.32
Organizations require different information in quantity and type according to
the context of the environment in which it operates.33
Organizations operating in a complex environment must
make decisions against ambiguous information, rapid change, and more ability to
predict results.34 In addition, each organization has its
appropriate values, ideas, and beliefs to regulate the behaviour of individuals
so that the work is done. Implementing organizational activities is a guiding
principle.35 To achieve the organization's goals, leaders must have
a complete and diverse understanding of the organization's culture.36
Also, for the organization to exploit the range of available opportunities, it
must adapt the rules and procedures of the structural design following its strategic
choices.37 Strategy is a complex structure that reflects the
interactions of the organization's parts and resources with its internal and
external environment.38 Accordingly, organizations with complex
strategies seek to be more flexible and adaptive to the changes surrounding
them.39
Organizational structure and
knowledge management processes
The success of organizations and enhancing their
competitiveness requires the adoption of systematic coordination of knowledge
operations departments and control of the barriers that hinder them, whether
internal barriers such as organizational structure and culture or external
environmental factors. The organizational structure provides options for
managing knowledge processes and the correct course from the beginning
knowledge creation until its implementation.40 Therefore,
organizations work to find dependent relationships between their departments to
acquire knowledge from various internal and external sources and preserve their
knowledge resources.41
The concept of knowledge and
knowledge management
Knowledge is a combination of experience, values, and
information that arises in the minds of individuals.42 It is a
translation of the values, principles, and cultural norms of the organization's
members that are embodied and organized according to its structure.43 However, knowledge management is a set of procedures and
methods for creating, assembling, and applying knowledge following the
principles of designing the organization to achieve the planned goals.44
It is also the process of the organization's awareness of its individual and
collective knowledge and working on directing it to achieve sustainable
excellence.45 Knowledge management allows acquiring knowledge from
various internal and external sources and distributing it among the
organizational levels to benefit from it effectively.46 It also
allows the organization to create, organize, disseminate, and apply knowledge
to meet its challenges and develop methods, techniques, and organizational
values that enhance the flow of knowledge among individuals.47 Thus,
knowledge management is an integrated system that creates and applies knowledge
to serve the organization's goals.48 Consequently, Knowledge
management represents a set of organizational activities and processes, the aim
or purpose of which is to create knowledge and work to preserve it, in addition
to transferring and sharing it until it is applied in the organization.
Organizational knowledge mediates the relationship
between an organization's contextual factors, such as strategy, structural
design, and the culture of its people.49 It is the strength and
basis of competition between organizations, and excellence lies in managing it
properly to keep pace with changes in the business environment.50
Knowledge varies according to the individual and accumulates through the
knowledge base acquired by the individual.51 It is not limited to
exploiting existing knowledge but generating new knowledge that serves the
organization's goals is possible.52 Structural complexities
characterize the types of knowledge. Explicit knowledge is formal and
systematic, which is expressed in words or numbers and can be documented or
stored in databases.53 Unlike tacit knowledge, it is knowledge that
is rooted in the minds of individuals, such as technical skills, where it is
difficult to encode and store.54 Tacit knowledge is reflected in the
actions and behaviours of the organization's members.55
The tacit knowledge is transformed into explicit
knowledge through dialogue between the organization's members.56
Among the obstacles to converting tacit knowledge into explicit knowledge is
the opportunism of individuals for knowledge and a desire for power. Also, the
organizational structure relies on high specialization, which hinders
interactions between individuals, the improper establishment of powers,
overlapping goals, and lack of motivation for individuals. The way of planning
and physical distribution of offices affects the way of communication between
individuals.57
Knowledge management processes
Organizations practice their activities in knowledge
management through knowledge acquisition, knowledge storage/retrieval,
knowledge sharing, and knowledge application. Knowledge acquisition is the
process of obtaining knowledge from various internal or external sources, as it
is considered a strategic commitment to the organization.58
Storage/retrieval of knowledge refers to preserving existing knowledge based on
traditional means such as written documents or advanced technology such as
databases.59 Sharing knowledge is represented in the exchange of
knowledge between the organization's members in formal ways, such as through
reports and notes or informal organizations of individuals in the work
environment.60 Thus, knowledge sharing is related to the
coordination mechanisms between the units adopted by the organization.61 Supervisors in the organization are considered the
essential sources for sharing and distributing Their knowledge to the
subordinates.62 At the same time, applying knowledge refers to using
the existing knowledge base in the organization to solve organizational
problems and achieve added value.63 In this regard, by tracking
knowledge management processes, the most crucial process is the application of
existing knowledge and its embodiment in the field. Knowledge without
application does not create added value for the organization.
Organizational design and supporting
knowledge management processes
In addition, the organizational structure is a
supportive mechanism for knowledge management processes. Organizations adopt
organizational structures that allow the creation of diverse knowledge and its
flow in all parts of the organization easily without any obstacles to working
on merging and coordinating between them, adopting flexible structural designs
that promote team behaviour and encourage collaboration and knowledge sharing,
providing knowledge infrastructure that works on the effective division of
responsibilities and the use of guidelines that help in the effective
management of knowledge operations.14,64,65
As well as
adopting the horizontal organizational structure and administrative empowerment
policies for sharing and distributing knowledge in the organization, designing
a motivating work environment for individuals, and increasing interactions to
exchange knowledge.66,67
C. J. Chen & Huang( 2007) illustrated that the organizational structure is one of the elements of
the organizational climate that affects knowledge management processes and
contributes to the embodiment of social interaction, which appears more in
decentralized and less formal organizations.40 The organizational
structure also positively affects the sharing and application of knowledge
among the organization's members.64 stated that the difference in
knowledge management processes is according to the different structural designs
approved by the organization and the adoption of flexible structural designs
that encourage interactions between individuals to share knowledge and
effectively manage it. According to Bhatt(2001),66 the hierarchical organizational structure hinders the
flow of knowledge in contrast to the horizontal structure that contributes to
sharing knowledge across organizations.
It is also possible to utilize the characteristics of
structural complexity to advance knowledge management goals. Knowledge
management practices follow the organizational structure's design mechanisms in
this context. In structurally complex organizations, knowledge is fragmented
between departments and units, which necessitates the creation of special units
in the structure to capitalize on the knowledge. It happens according to the
specificity of the organization and its knowledge needs.68
Furthermore, the most critical barriers to knowledge sharing in organizations
are individual, technological, and organizational barriers. The importance of
the flexible structure as a supporter of knowledge sharing, and organizations
should study the obstacles to employee communication and knowledge sharing.69
For instance, most studies agree on the interdependence and integration between
flexible structures and knowledge management processes. However, the
specificity of the activity of some organizations does not enable them to adopt
flexible structures because they need to meet the current and future
requirements of the organization. Therefore, the appropriate strategic options
impose the adoption of structural complexity in its dimensions and an attempt
to reconcile it with Knowledge management processes.
Materials and Methodology
The study literature and
information related to the dimensions of structural complexity and knowledge
management require the organization appropriate to the problem to have its
outputs based on the skills and knowledge of its individuals rather than organizations
based on simple tasks that require mutual adaptation and unification of
individuals' behaviors. Thus, the Algeria- Cuba Friendship Ophthalmology
Hospital in Djelfa, Algeria, is the appropriate
organization to study the research problem.
The questionnaire was designed
based on previous literature related to the study variables. In the first
stage, we obtained the acceptance of the hospital's general director for the
field study procedures and determined a time frame for them. Among the receiving
organization's amendments, the hospital administration stipulated that the
questionnaire must be in Spanish as the hospital's doctors' native language.
Then, the hospital's Cuban party coordinator received the first final version
for arbitration. Based on his opinions, the content was modified. Hence, some
items that did not comply with hospital policy were deleted, and others were
drafted to their final form.
Among the most significant
proposed amendments. The item "My work involves a great deal of
interaction with people outside the hospital." The item "I find it
challenging to communicate with my colleagues in the hospital." was
changed to “I interact with my colleagues in the hospital." reformulating
the item, "I get the knowledge I need to work in the hospital by
myself." to "I know the necessary to do in my work in the hospital on
my own." Deleting the item “The hospital relies on the archive to preserve
knowledge." As for the study population, the questionnaire distribution
was limited to a certain number of the population, and the hospital
administration took responsibility for that. Also, most of them were reluctant
to answer.
The first purpose of this
research is to know the responses of the sample members to the various items of
the scale contained in the questionnaire. Then, to conclude the sample
direction for each item of the study. The research relied on a five-point Likert
scale based on 5 points. Table 1
shows this.
Table 1. Five-point
Likert scale tool
|
Scale |
Level |
Range |
|
1 |
Never |
[00,1-1,79[ |
|
2 |
Rarely |
[80,1-2,59[ |
|
3 |
Occasionally |
[60,2-3,39 [ |
|
4 |
Frequently |
[40,3-4,19[ |
|
5 |
Always |
[20,4-5,00] |
Statistical analysis of the sample’s views
Structural complexity variable
It is clear from Table 2 that item 04, “My employment
requires me to analyze hospital information.” is the
highest among the means, with a mean of 3.2400 and a standard deviation of
1.42244. The trend of this item may be explained by the difficulty of meeting
the needs of patients and the lack of ways to standardize the response to
different conditions and health problems. It is consistent with De Jonge et al.(
2001)70 study that concluded that in order
to manage hospitals successfully, the latter requires complex knowledge as a
result of the impossibility of adopting a unified diagnosis for all patients,
the multiplicity of therapeutic interventions and consultations, and the need
for strong coordination between various medical staff, including doctors and
nurses. In addition, item No. 03, "The outcomes of my work contribute to
the hospital careers of others." came in last place, with a mean of 2.9200
and a standard deviation of 0.996660. This result refers to the difficulty of
relying on the results of the various components of the staff and the need for
more cooperation between the various organizational units in the hospital.
Table 2. Horizontal differentiation dimension
|
No. |
Item |
Mean |
SD |
Trend |
|
1.
|
It took time to learn the equipment used in the hospital. Me tomó tiempo aprender el material que se usa en el hospital. |
2.2400 |
1.36260 |
Rarely |
|
2.
|
I use a variety of skills in the hospital in order to complete my
work. Uso una
variedad de habilidades en el hospital para completar mi trabajo |
3.1200 |
1.39403 |
Occasionally |
|
3.
|
The outcomes
of my work contribute to the hospital careers of others. Los resultados de mi trabajo contribuyen al trabajo de los demás. |
2.9200 |
0.99666 |
Occasionally |
|
4.
|
My employment
requires me to analyze hospital
information. Mi trabajo requiere que usé y analicé mucha información en el hospital |
3.2400 |
1.42244 |
Occasionally |
|
5.
|
The organizational goals in the hospital are multiplicity and
diversity depending on the diversity of the departments. En la organización del hospital, cada departamento
tiene una serie de objetivos diversos. |
3.0400 |
1.30639 |
Occasionally |
Source: elaborated by researchers based on outputs of
SPSS 22 software.
Table 3 shows item No. 10, "Information flows in the hospital to multiple
administrative levels." is the highest among the means, with an arithmetic
mean of 3.1600 and a standard deviation of 1.59896. The trend of this item
directs to the multiplicity of hierarchical levels, the engagement of
decision-making authority with the manager, and the lack of work on the
principle of delegation. The research of Parand et al.(2014)71
concluded that one of the tasks of hospital managers is to make decisions
and formulate various administrative procedures and policies that ensure the
provision of quality healthcare services. Also, Item No. 08: "There is
more than one official in the hospital from whom I take orders." It came
with an arithmetic mean of 2.6000 and a standard deviation 1.58114. The trend
of this item is explained by the multiple scopes of supervision for each
individual due to the overlapping of the responsibilities assigned to them.
Furthermore, it refers to the need for more understanding of them completely
and correctly.
Table 3. Vertical differentiation dimension
|
Item |
Mean |
SD |
Trend |
|
|
I find it
challenging to communicate with the upper levels of hospital administration. Me resulta difícil
comunicarme con los niveles
superiores de la administración
del hospital. |
1.8400 |
1.24766 |
Rarely |
|
|
There are
multiple steps to permit the completion of my duties in the hospital. Hay varios pasos para autorizar
el cumplimiento de mis funciones
en el hospital. |
2.9200 |
1.57903 |
Occasionally |
|
|
There is more
than one official in the hospital from whom I take orders. Hay más de un funcionario en el hospital de quien recibo indicaciones. |
2.6000 |
1.58114 |
Occasionally |
|
|
The
hospital management reviews the organizational relationships between the administrative
levels continuously. La dirección del hospital revisa las relaciones organizativas entre
los niveles administrativos
de forma continua. |
2.7600 |
1.20000 |
Occasionally |
|
|
Information
flows in the hospital towards multiple administrative levels. La información fluye en el hospital hacia múltiples niveles
administrativos. |
3.1600 |
1.59896 |
Occasionally |
Source: elaborated by researchers based on outputs of SPSS 22 software
Table 4 depicts item No. 12. "The hospital's activities are spread over
different locations." is the highest among the means with an arithmetic
mean of 3.6400 and a standard deviation of 1.52425. The trend of this item was
frequent. Thus, spatially dispersed units and departments require effective
coordination, as each patient is subject to fragmented health services across
the hospital's physical locations. Tamuz &
Harrison( 2006)72 claim that hospitals
are unique in their organization compared to other departments and the
interaction of their parts in an organized and bureaucratic manner to achieve
multiple goals within the framework of a complex and distinct system. The item
"The hospital's activities are spread over different locations." came
last. The trend of this item was rare. Hence, the hospital is activating
multiple medical specialties, which makes it difficult to cooperate and work
collectively with parties outside the hospital's affiliation. In this
regard, Mamédio &
Meyer (2020)73 argued that high complexity exists
in hospitals due to several factors, the most important of which are the
specificity of the services provided, the techniques and technology used, the
type of skills and knowledge required, and unexpected situations.
Table 4. Spatial
differentiation dimension
|
No. |
Item |
Mean |
SD |
Trend |
|
The hospital assigns the
completion of some tasks to other institutions to achieve them better. El hospital
asigna la realización de algunas tareas a otras instituciones. |
2.0800 |
0.99666 |
Rarely |
|
|
The hospital's activities are spread over different
locations. Las actividades del hospital se
reparten en diferentes servicios |
3.6400 |
1.52425 |
Frequently |
|
|
I interact with my colleagues in the hospital. Me relaciono
con mis compañeros en el hospital. |
3.2800 |
1.54164 |
Occasionally |
Source:
elaborated by researchers based on outputs of SPSS 22 software
Generating
and acquiring knowledge
Table 5 above states that in item 16, " I get the
knowledge I need to work in the hospital by myself." It is the highest
among the averages, with an arithmetic mean of 3.2400 and a standard deviation
of 1.56205. The trend for this item was occasionally. It explains that the
complexity in hospitals encourages work based on a shared vision of knowledge
and expertise and the formation of work teams that promote finding solutions to
patients' cases. In the same context, Costa et al.'s ( 2014)74 study confirms that one of the
most critical challenges healthcare workers face is finding the correct
diagnosis for patients' cases based on their knowledge.
Table 5. Knowledge management axis
|
No. |
Item |
Mean |
SD |
Trend |
|
The
interaction between me and my colleagues increases the generation of new
knowledge in the hospital. Existe un
intercambio entre mis colegas y yo para generar nuevos conocimientos e ideas
en el hospital. |
2.8800 |
1.36382 |
Occasionally |
|
|
I participate
in teamwork to gain new experiences in the hospital. Participo en
trabajo en equipo para adquirir nuevas experiencias en el hospital. |
2.8400 |
1.28062 |
Occasionally |
|
|
I get the
knowledge I need to work in the hospital by myself. Tengo los
conocimientos necesarios para realizar mi trabajo en el hospital por mi
cuenta |
3.2400 |
1.56205 |
Occasionally |
|
|
4. |
Training
programs in the hospital help me to acquire new knowledge. Los programas de
formación en el hospital me ayudan a adquirir nuevos conocimientos. |
2.4400 |
1.22746 |
Rarely |
|
5. |
I write down
the experiences I do in the hospital. Anoto las
informaciones que hago en el hospital. |
2.7200 |
1.36991 |
Occasionally |
|
6. |
The hospital
uses software to store knowledge. El hospital utiliza
software para almacenar conocimiento. |
3.0400 |
1.39881 |
Occasionally |
|
7. |
I keep my
colleagues updated on the knowledge I gain in the hospital. Mantengo
actualizados a mis colegas sobre los conocimientos que adquiero en el
hospital. |
3.2400 |
1.20000 |
Occasionally |
|
8. |
The hospital
seeks to facilitate sharing knowledge with my colleagues by organizing
training courses. El hospital
busca facilitar el intercambio de conocimientos con mis colegas mediante la
organización de cursos de formación |
1.8800 |
.88129 |
Rarely |
|
9. |
I use the
technological facilities to share knowledge with my colleagues in the
hospital. Utilizo las
instalaciones tecnológicas para compartir conocimientos con mis compañeros
del hospital. |
2.4000 |
1.41421 |
Rarely |
|
10.
|
The Internet
is the most important means of delivering knowledge in the hospital. En el hospital,
Internet se utiliza como el medio más importante para transmitir
conocimientos. |
3.0400 |
1.61967 |
Occasionally |
|
11.
|
I help my
colleagues apply their knowledge in the hospital. Ayudo a mis
compañeros a aplicar sus conocimientos en el hospital. |
2.8400 |
1.21381 |
Occasionally |
|
12.
|
The hospital
administrators continually assess my knowledge. Estoy sujeto a
evaluación continua por parte de los jefes de hospital para asegurar mis conocimientos. |
2.0000 |
1.04083 |
Rarely |
Source: elaborated by researchers based on outputs of SPSS 22 software
Knowledge storage
Item No. 19: “The hospital
uses software to store knowledge.” It is the highest among the averages, with
an arithmetic mean of 3.0400 and a standard deviation 1.39881. This item trend
was occasionally. This result is explained by not relying entirely on technology
to store knowledge, as there is implicit knowledge due to complex experiments
to extract and declare. For instance, according to de Zwart et al.(
2023)75 research, the complexity of
hospitals requires adapting to changing circumstances and making decisions that
require special knowledge and skills to deal with cases and their various
treatment options.
Share knowledge
Item No. 20 states, “I keep my
colleagues updated on the knowledge I gain in the hospital.” is the highest
among the means, with a mean of 3.2400 and a standard deviation of 1.20000, and
the trend for this item was occasionally. It is explained that to value the
customary storage in the hospital, the tacit knowledge of individuals must be
brought out through dialogue and informal organizations in the hospital. This
is confirmed by item 22, “I use the technological facilities to share knowledge
with my colleagues in the hospital.” which came in last place. This is
consistent with Lee et al. 2014 study,76 which claimed that good
hospital performance outcomes are associated with a solid organizational
culture promoting knowledge sharing.
Application of knowledge
Item No. 24, “I help my
colleagues apply their knowledge in the hospital.” is the most increased among
the means, with a mean of 2.8400 and a standard deviation of 1.21381. The trend
of this item was occasionally. It can be explained by the fact that the complex
structure of the hospital results in the isolation of departments and may not
allow for common spaces between individuals to exchange information and
disseminate best practices for applying knowledge.
Study model
The model is established by
studying the impact of structural complexity and its dimensions on knowledge
management processes at the Friendship Algeria Kuba Ophthalmology Hospital in Djelfa. The study model was proposed using the structural
equation modelling method using the partial least squares method. The study
includes an independent variable related to structural complexity in three
dimensions (Figure 1). The dependent
variable relates to the knowledge management dimension. Table 6 depicts this:
Table 6. Items model description
|
Dimension |
Items |
|
Horizontal differentiation |
Hori1, Hori2 ,Hori3 ,Hori4 |
|
Vertical differentiation |
verti1, verti2, verti3, verti4
,verti5 |
|
Spatial differentiation |
Spati 1,Spati2
,Spati 3 |
|
knowledge management |
Know1,Know2,Know3,Know4,Know5,Know6, Know 7,Know8,Know9,Know10,Know11,Know12 |
Source: elaborated by researchers based on
outputs of smart pls 4 software
Figure 1. PLS-Model building
Source: elaborated by
researchers based on outputs of smart pls 4 software
.
Study model
test:
Evaluation
of the measurement model: The criteria of convergent validity and discriminant
validity are used to evaluate the accuracy of items and the suitability of
scale measurement.
Convergent
validity
To verify
the convergent validity of the study measurement, loadings, composite
reliability, and average extracted variance are measured, as shown in Table 7:
Table 7. Construct Reliability and Validity
|
Constructs |
CR |
AVE |
Items |
Factor
Loadings |
|
Horizontal differentiation |
0.859 |
0.558 |
Hori1 Hori2 Hori3 Hori4 Hori5 |
0.501 0.883 0.783 0.703 0.806 |
|
Vertical differentiation |
0.833 |
0.532 |
verti1 verti2 verti3 verti4 verti5 |
0.182 0.791 0.870 0.842 0.732 |
|
Spatial differentiation |
0.675 |
0.411 |
Spati 1 Spati2 Spati 3 |
0.645 0.704 0.566 |
|
knowledge management |
0.804 |
0.337 |
Know 1 Know2 Know3 Know4 Know5 Know6 Know7 Know8 Know9 Know 10 Know11 Know12 |
0.879 0.818 0.798 0.254 0.251 0.995 0.784 0.149 0.426 0.585 0.850 0.899 |
Source: elaborated by researchers based on outputs of
smart pls 4 software
It is clear
from Table 6 that there are some
items whose saturations were less than the criterion specified for full
acceptance of 0.40. Thus, they must be deleted due to their impact on the
standard model's composite reliability, internal consistency, and discriminant
validity. Meanwhile, item saturation is between 0.40-0.70. In that case, it
will be necessary to verify the effect of deleting this item on raising the
value of the rest of the standards of the structural model. On the other hand,
the items whose saturation equals or exceeds 0.70 are kept because they belong
to this dimension. After the process of deleting the items and improving the
model, Table 8 is formulated.
Table 8. Construct Reliability and Validity
|
Constructs |
CR |
AVE |
Items |
Factor
Loadings |
|
Horizontal differentiation |
0.859 |
0.741 |
Hori2 Hori3 Hori5 |
0.890 0.867 0.823 |
|
Vertical differentiation |
0.887 |
0.663 |
verti2 verti3 verti4 verti5 |
0.782 0.885 0.852 0.728 |
|
Spatial differentiation |
0.740 |
0.588 |
Spati 1 Spati 2 |
0.732 0.801 |
|
Knowledge management |
0.913 |
0.677 |
Know 1 Know3 Know7 Know11 Know12 |
0.895 0.828 0.825 0.748 0.812 |
Source: elaborated by researchers based on outputs of smart pls 4
software
Discriminant
validity
1.
Cross -loading test
The
cross-loading test aims to ensure that the items represent the dimension to
which they belong. For this reason, their values must be higher than the rest
of the dimensions. Table 9
demonstrates that the study axes do not overlap and that the variables are
independent and belong to the dimension they represent.
Table 9. Cross-loading
test
|
Horizontal
differentiation |
Vertical
differentiation |
Spatial
differentiation |
Knowledge
management |
|
|
0.623 |
0.687 |
0.425 |
0.895 |
Know 1 |
|
0.718 |
0.588 |
0.453 |
0.828 |
Know3 |
|
0.633 |
0.674 |
0.708 |
0.825 |
Know7 |
|
0.679 |
0.805 |
0.407 |
0.748 |
Know11 |
|
0.53 |
0.606 |
0.172 |
0.812 |
Know12 |
|
0.364 |
0.37 |
0.732 |
0.394 |
Spati1 |
|
0.451 |
0.466 |
0.801 |
0.434 |
Spati2 |
|
0.88 |
0.890 |
0.53 |
0.751 |
Hori2 |
|
0.756 |
0.867 |
0.393 |
0.672 |
Hori3 |
|
0.54 |
0.823 |
0.489 |
0.706 |
Hori5 |
|
0.782 |
0.672 |
0.557 |
0.594 |
verti2 |
|
0.885 |
0.796 |
0.363 |
0.722 |
verti3 |
|
0.852 |
0.72 |
0.339 |
0.724 |
verti4 |
|
0.728 |
0.575 |
0.495 |
0.45 |
verti5 |
Source: elaborated by researchers based on
outputs of smart pls 4 software
1.
variable correlation
Fornell Larcker criterion:
This criterion compares the square root of the AVE values with other
correlations of the latent variable (Table
10). Thus, the square root of the AVE value for each construct must be
greater than its highest correlation with any other construct. (See Figure 2)
Table
10. Fornell Larcker test
|
Vertical |
Knowledge |
Horizontal |
Spatial |
|
|
|
|
|
0.767 |
Spatial
differentiation |
|
|
|
0.861 |
0.548 |
Horizontal
differentiation |
|
|
0.81 |
0.855 |
0.534 |
Vertical differentiation |
|
0.776 |
0.760 |
0.797 |
0.540 |
Knowledge
management |
Source: elaborated by researchers based on outputs of smart pls 4 software
Figure 2: PLS-Model final
model.
Source: elaborated by researchers based on outputs of
smart pls 4 software
Structural
model evaluation
The
structural model is evaluated using a set of criteria. The coefficient of
explanation or determination implies the capacity of the structural complexity
to explain the changes that occur in the knowledge management variables. The
value of the coefficient of determination, R2, ranges from 0 to 1,
and levels close to 1 reveal increased predictive accuracy (Table 11). The effect size indicator
f², a significant tool, is utilised to analyse and determine the size of the
effect of structural complexity on knowledge management (Table 12).
Table 11. Coefficient
of Determination (R2)
|
Construct |
R-Square |
R-Square
adjusted |
|
knowledge management |
0.795 |
0.766 |
Source: elaborated by researchers based on outputs of
smart pls 4 software
Table 12. effect size
results
|
|
Knowledge management |
|
Spatial differentiation |
0.698 |
|
Horizontal differentiation |
0.330 |
|
Vertical differentiation |
0.007 |
Source: elaborated by researchers based on outputs of
smart pls 4 software
The Smart
PLS program is used to test the study hypotheses. This program relies on path
analysis using Bootstrapping, which focuses on the path coefficient, T-values,
and p-values. Table 13 depicts this.
Table 13. Specific Indirect Effects
|
p-Values |
T-Values |
STDEV |
Sample mean |
|
|
0.001 |
3.313 |
0.140 |
0.440 |
Spatial differentiation |
|
0.000 |
3.521 |
0.138 |
0.514 |
Horizontal differentiation |
|
0.585 |
0.547 |
0.142 |
0.087 |
Vertical differentiation |
Source: elaborated by researchers based on outputs of
smart pls 4 software
Table 13 shows how the dimensions of structural
complexity were independently tested on the knowledge management processes of
the Friendship Algeria Kuba Ophthalmology Hospital in Djelfa
City. The first sub-hypothesis: The probability value of the spatial
differentiation variable is 0.001, which is less than the significance level of
0.05, and therefore, the alternative hypothesis H1 is accepted. The spatial
differentiation dimension statistically affects knowledge management processes
at the Friendship Algeria Kuba Ophthalmology Hospital in Djelfa
City.
The second
sub-hypothesis: the probability value of the horizontal differentiation
variable is 0.000, which is less than the significance level of 0.05.
Therefore, we accept the alternative hypothesis H1, which states that there is
a statistically significant effect of the horizontal differentiation dimension
on the knowledge management processes at the Friendship Algeria Kuba
Ophthalmology Hospital in Djelfa City.
The third
sub-hypothesis: the probability value
of the vertical differentiation variable is 0.585, which is greater than the
significance level of 0.05. Therefore, the null hypothesis H0 is accepted,
which states no statistically significant effect of the vertical
differentiation dimension on knowledge management processes at the Friendship
Algeria Kuba Ophthalmology Hospital in Djelfa City.
Conclusion
Organizational
structure design policies vary according to several considerations, the most
important of which are the organizations' specificity and activity and the
mechanisms adopted for coordination between their parts. Accordingly, this
study sought to test the relationship between the dimensions of structural
complexity in the Friendship Algeria Cuba Ophthalmology Hospital practices in Djelfa and knowledge management processes. Health
organizations are composed of a complex system that contains disparate inputs
represented by the external environment of the hospital, individual
practitioners with their various knowledge, and patients, and the goal of their
outputs is to achieve quality health results.77
Thus, emphasis must be placed on
knowledge management processes, as hospital management requires effective
management of its professional knowledge to make decisions that achieve
high-quality services for patients and the hospital achieve a good reputation,78
especially with the recommendations imposed by the coronavirus pandemic, which
require searching for future trends in the field of hospital organization and
management.79 In this regard, one of the most essential
regulatory standards in place in the field of health organizations is to
benefit from developments in the technology environment to discover solutions
to complex health cases.80 In addition, creating functions in
organizational structures reduces the pressure on doctors due to the complexity
of their tasks and the overlap of their responsibilities.81
Hospitals are complex systems requiring strategic choices to structure
knowledge acquisition and dissemination at all organizational levels properly.82
All this is done to effectively produce multiple options to meet the hospital's
needs.83
The current
research concluded that spatial and horizontal differentiation had a
significant effect on knowledge management processes in the organization
studied. However, vertical differentiation has no statistically significant
effect on knowledge management processes. Thus, spatial differentiation results
in the fragmentation of health care for patients between different physical
locations, leading to obstructed communications between them and delayed access
to information, negatively affecting the diagnosis of patients’ cases. However,
the hospital administration overcame the obstacles of spatial differentiation
by targeting knowledge management processes by adopting communication
technology and integrating it into hospital operations.
Regarding
horizontal differentiation in the organization, we notice the process of
arranging hospital departments based on hospital-specific functions such as
examinations A, examinations B, and the surgery unit. Each department
specializes in a specific healthcare field and has a range of knowledge,
experience and medical equipment in addition to various supporting departments
such as laboratory and radiography. They work together in an integrated manner
because each department has a deep understanding of its field of
specialization, which facilitates the application of knowledge. The outputs of
each department are the inputs of the department with which it is linked.
Therefore, coordination between departments must be strengthened to acquire new
knowledge and skills that improve the outcomes of hospital operations.
As for vertical differentiation in the
organization, it is noted that there are multiple hierarchical levels in the
hospital, and the concentration of decision-making authority with the director
results in the flow of information across Many levels, which leads to a delay
in the dissemination of knowledge. In addition, knowledge may be monopolized at
higher levels, while lower levels have incomplete and unclear knowledge. The
research points out the lost knowledge that cannot be stored in the hospital’s
knowledge repositories.
Furthermore,
systems that align with technological developments must be adopted to
effectively manage knowledge and overcome the negatives of multiple
hierarchical levels, delegating some powers and empowering individuals.
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Conflicting Interests:
The authors report no conflicts of interest.
Contribution of authors:
·
Mokhtar Rabhi: Conceptualization, Data curation, Formal
analysis, Methodology, Supervision,
Writing. Project administration, Software.
·
Rima Affaf Harizi: Conceptualization, Data
curation, Formal analysis, Methodology, Investigation. Software.
·
Mohammed Said Djoual: Conceptualization, Data
curation, Formal analysis, Methodology, Supervision, Project administration.
·
Ahlam Thamri: Conceptualization, Investigation.
Software.
·
Souaad Benmessaoud: Conceptualization,
Software.