Knowledge management effects and performance in health care: a systematic literature review

ABSTRACT

Knowledge management is intended to achieve organisational goals through effective management of knowledge resources and performance. This paper presents a review of knowledge management effects and performance in health care. Six databases were searched, the searches employing Boolean operators and combinations of key words. In total, 16 articles fulfilled the criteria set for inclusion. Data were analysed using inductive content analysis. The review shows that in health care knowledge management effects and performance have been viewed from various perspectives: it has been linked to health care functions such as management, finance, patient care, quality and safety, IT, continued improvement of clinical operations, and organisational culture. However, the effects of knowledge management extend also to employees’ work, job satisfaction, learning, knowledge distribution, and productivity. This review aims to summarise the recent research on knowledge management effects and performance in health care. Some of the effects are universal and some are context-specific.

KEYWORDS:

• Knowledge management
• effects
• performance
• hospital
• health care
• literature review

1. Introduction

This review presents some of the effects and considers the performance of knowledge management (KM) in health care structures. KM remains a complex subject with much more still to be explored both in general settings and in health care specifically (Castillo & Cazarini, 2014). Currently, KM is one of the most discussed of the various management models which are intended to achieve organisational goals through more effective control of an organisation’s knowledge resources and performance (Andreeva & Kianto, 2012; Wiig, 1997). The literature on knowledge processes and organisation performance has discussed in detail how activities, such as knowledge creation, acquisition, sharing, utilisation, storage, transfer, and application are related to different organisation performance outcomes (Chen & Chen, 2006; Inkinen, 2016; Zaim et al., 2019). The various approaches of KM all ultimately aim to describe and explain changes in the content of knowledge over time and the effects of those changes on organisational performance (Argote et al., 2003). Researchers have devoted a great deal of attention to empirical examinations of the link between KM and business performance (Cohen & Olsen, 2015), but one area that has not received much interest is the public sector (Sandhu et al., 2011). In the health care context KM has been a fairly unfamiliar management model and research into the subject has been limited at best (Massaro et al., 2015; Sibbald et al., 2016). Some researchers view KM capabilities as independent predictors of performance and suggest that their effects are universal (Andreeva & Kianto, 2012; Wang & Wang, 2012). In contrast, other researchers have established that organisational structure is related to high levels of formalisation and, hierarchy and suggest that centralisation has a negative effect on organisational performance (Zheng et al., 2013).

Health care organisations have been called knowledge-intensive organisations since knowledge is their most vital asset (Sandhu et al., 2011). Concurrently, they are often regarded as static, tradition-guided, hierarchal, and with strictly predefined organisational functions, a structural combination which is seen as a challenge for the development of KM (Isosaari, 2011; Porter & Teisberg, 2006). In health care, highly specialised professionals operate in hierarchical arrangements across different organisational units. This operational arrangement has many effects on the ability of these organisations to utilise KM since it creates operational, professional, and unit wide silos. (McCracken & Edwards, 2017; Van Beveren, 2003). KM is not viewed as limited to organisational-level performance management; rather, it seeks to recognise the wide and differentiated knowledge needs of all health care professionals (Ikonen, 2020). The complex profession of health care is at a particular disadvantage with regard to effective knowledge sharing (Radević et al., 2021): factors which are related to the sharing – or indeed the non-sharing – of knowledge in health care are the structure of the social network(s), time and place, organisational culture, trust, motivation, and the type of knowledge being shared (Ipe, 2003; Radević et al., 2021). Current KM practices are largely focused on the use of information technologies; a criticism of this approach is that these practices do not support knowledge sharing in organisations. (Rusell et al., 2004.)

Applications of KM in health care face several challenges, some of which are directly shaped by the unique nature of health care services. Some of these challenges are, however, common to other fields of society, too. (Riege, 2005). KM activities can be characterised as the systematic creation, modelling, sharing, operationalisation, and application of health care knowledge to improve the quality of patient care (Candra & Putrama, 2018; Jackson, 2000). Organizational learning can increase organisational effectiveness and efficiency through shared knowledge and understanding (Ratnapalan & Uleryk, 2014). The goal is to provide optimal, timely, and effective health care knowledge to professionals in order to help them make high-quality, well-informed, and cost-effective decisions (Jackson, 2000). KM is undoubtedly an important part of any organisation’s management processes (Davenport & Prusak, 1998), but its effects and performance vary in health care for different reasons, among which are idiosyncratic organisational cultures and goals (Tang, 2017). KM effects and performance describe largely similar phenomena in health care, but the perspective of effects does tend to be rather narrow. The concept of performance, in contrast, is broader and describes the overall KM success of an organisation. (Rainey & Steinbauer, 1999).

Effects – good and bad – help determine what actors and organisations should strive to accomplish in known activities (Munro, 2004). They offer keys which draw attention, define discourse, and (re)orientate actions in certain directions (Dahler-Larsen, 2007). Organizations are viewed as effective if they achieve their stated goals (Lewin & Minton, 1986). Vedung (1997) classified effects under the broad headings of customer satisfaction, personnel, quality, knowledge, and financial. In health care, knowledge is a necessary condition for evidence-based practice, and the main need is for a tool that allows employees to find the right information at the right time (El Morr & Subercaze, 2010). Effective KM, it should be noted, results in improved patient safety and quality performance in health care (Candra & Putrama, 2018; Choo et al., 2007; Paul, 2006); this is all the more significant given that the rising costs of health are in turn pushing administrations to find more effective ways to deliver care (Vedung, 1997).

Normally, organisational performance includes multiple dimensions (Selvam et al., 2016; Van Thiel & Leeuw, 2002). KM performance from a balanced scorecard (BSC) perspective includes: the customer perspective, internal business perspective, innovation, the learning perspective, and financial perspective – all of, which are used as indicators of KM performance (Chen et al., 2009). Performance measurement is an important part of KM as without some kind of measurement organisations are unable to make judgements regarding how to continue, what to improve, and what to discard (Andone, 2009). Effective performance measurement systems include critical success factors, a mix of financial and non-financial data, and a balance between different views. The most frequent critique of performance systems maintains that these systems have many unintended effects, both positive and negative (Courtney et al., 2004). Assessments of health care performance have introduced in different concepts, like productivity, efficiency, organisational effectiveness, and cost effectiveness. However, performance in health care should basically be patient-centred, and organisational performance cannot be enhanced and maintained without achieving a good satisfaction level among patients (Duygulu & Kublay, 2011; Shaikh & Hatcher, 2004). KM can promote such organisational performance only when members of the health care profession actively share and consciously use their knowledge to that end (Luo & Lee, 2013).

In the management literature, there are many reviews dealing with KM in health care, including studies looking at clinical processes, tools, and implementation (Karamitri et al., 2017; Kothari et al., 2011; Lunden et al., 2017; Nicolini et al., 2008; Rocha et al., 2012; Shahmoradi et al., 2017). However, more studies are needed due to the lack of understanding about the association between KM and organisational performance (Inkinen, 2016). Our review is all the more meaningful because the systematic analysis of the effects of KM and its performance in health care contexts is still very incomplete (Kothari et al., 2011). Indeed, we found no previous literature reviews that summarised the effects of KM and its performance in health care. Hence the main aim of this review is to identify and summarise the currently available evidence on KM effects and performance in health care. The review proceeds by gathering the relevant information together, reorganising it in several categories, and finally determining how KM practices are associated with health care effects and performance (Torraco, 2005). KM has been previously studied from the clinical perspective, but in this paper it is viewed from an organisational perspective. This study will be useful to future KM research as it points the way to further development and research within health care. The essential purpose of the research is to answer the following questions: 1) What KM effects have been identified in health care? 2) How is KM performed in health care? In short, the paper summarises the results of a systematic literature review on the operation of KM within hospitals and other health care settings.

2. Research methods

2.1. Study design and the search process

We used a systematic literature review to identify studies that describe diverse types of knowledge management effects and performance in health care. This literature review was conducted following Moher et al. (2015) seven-step process, as follows: 1) formulate research questions; 2) after some initial searches, select the most relevant search terms and formulate search phrases by consulting an information specialist in the field of health and social sciences; 3) plan a search strategy, working together with an information specialist; 4) agree on inclusion and exclusion criteria; 5) conduct a systematic search of relevant electronic databases; 6) select eligible research articles; and 7) perform a quality appraisal of the studies selected for the review.

The systematic search was conducted in Cinahl, PubMed, Scopus, Web of Science, ABI/Inform databases, and Business Source Complete in June 2019. Searches were performed by employing combinations of key terms and using the Boolean operators AND and OR. Our search terms are presented in Table 1. Relevant search results were found in all databases except Business Source Complete. In order to obtain as comprehensive search results as possible, different search terms were used. A number of search limits were imposed: these included research articles in English language titles only: studies published between 2008 and 2018 because we wanted to follow the timeline relative to previous systematic reviews; and peer-reviewed empirical studies with a quantitative, qualitative, or mixed methods research design; studies also had to answer the research questions. All of the studies identified were cross-sectional.

Table 1. Search terms.

Knowledge management	Health care	Effects and performance	Boolean terms
“knowledge management”[Mesh] knowledge management*	“hospitals”[Mesh] hospital delivery of health care”[Mesh] healthcare* health care* “health services”[Mesh] health service	“outcome assessment (health care)”[Mesh] outcome* effect* performance*	AND OR

2.2. Data collection

The initial search procedure yielded 1669 papers in the ten-year time period 2008–2018. All relevant titles and abstracts were screened, and those articles not meeting the inclusion criteria were immediately excluded. Exclusion criteria were applied to editorials, literature reviews, discussion papers, conference papers, books or reports, patients-focused research, and research that did not answer the research questions. The remaining studies included empirical qualitative, quantitative or mixed method research papers. After eliminating duplicates and reading the papers, the number of search outcomes was curtailed from 185 to 52. After thoroughly reading each, 21 studies were included in the quality assessment process, and finally 16 studies were deemed eligible. All of these selected articles focused on KM effects and performance in health care. Most of the articles covered both these perspectives; two articles described the KM process from the point of view of knowledge acquisition, creation, sharing, transfer, and application. We excluded these articles because they did not focus on effects and performance. The process of data collection is presented in Figure 1.

Figure 1. Flow process of data collection.

2.3. Quality assessment

All studies that met the inclusion criteria were assessed for methodological adequacy. We used the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Interpretive and Critical Research to assess the methodological quality of the selected articles (Lockwood et al., 2015). Critical appraisal criteria were used to get a sense of the congruity between the philosophical perspective, research methodology (including research questions or objectives), methods used to collect data, the representation and analysis of data, and the interpretation of results.

2.4. Content analysis

The16 selected articles were read through several times to internalise their contents and to detect central themes. The selected papers – from PubMed (3), Cinahl (2), Scopus (4), Web of Science (4), and ABI/ Inform (3) – met the inclusion criteria and passed the quality assessment. After the search process was complete, the focus switched to content that was relevant to the aim of this study. The data were analysed using inductive content analysis (Elo & Kyngäs, 2008; Torraco, 2005). The results obtained were classified and finally formed into upper classes. The researchers discussed and agreed all research choices made at different stages of the research process. The studies are presented in chronological order in Table 2.

Table 2. Summary of previous studies of KM effects and performance.

Authors	Purpose	Study design	Respondents
1. Orzano et al. (2008) USA	To identify how family medicine practices exhibit KM	Comparative case study n = 4	Family medicine practices
2. Tien et al. (2008) Taiwan	To understand the relationship between KM and organisational operation in medical organisation	Case interview n = 3 Survey n = 92	Directors and secretary Employees in clinic and hospital
3. Gowen et al. (2009) USA	To tests the degree to which KM could act as a mediator of the effects transformational leadership and quality management	Survey n = 370	U.S. hospitals
4. Chang et al. (2011) Taiwan	To evaluate performance of KM among hospital employees	In-depth interviews n = 3 Survey n = 154	Policy-makersDirectors in hospital
5. Wu and Hu (2012) Taiwan	To understand hospital performance	Survey n = 144	Hospitals
6. Griffith et al. (2013) USA	To identify common KM strategies and examine KM elements in health care	Qualitative study n = 39	Acute care hospitals
7. Lee et al. (2014) South Korea	To investigate the levels of implementation of KM and outcomes of nursing performance	Survey n = 192	Nurses in health care organisations
8. McFadden et al. (2014) USA	To examine how KM mediates the relationship between quality improvement initiatives and patient safety learning outcomes	Survey n = 273	U.S. hospitals
9. Ocak et al. (2015) Turkey	To reveal the effects of organisational culture and KM applications on patient safety performance	Survey n = 122	Nurses in hospital
10. Alajmi et al. (2016) Kuwait	To investigate the relationship between KM practices and performance	Survey n = 277	Doctors in hospitals
11. Körner et al. (2016) Germany	To identify what extent knowledge integration predicts perceptions of teamwork and team performance	Survey n = 317	Health care professionals in the rehabilitation clinics
12. Lee (2017) Korea	To investigate the effects of KM enablers	Survey n = 779	Tertiary hospitals employees
13. Tang (2017) China	To investigate the influence of KM on organisational culture and organisational effectiveness	Survey n = 266	Doctors and medical professionals in hospital
14. Ajanaku and Mutula (2018) Shouth West Nigeria	To investigate the relationship between KM and performance of nursing care	Survey n = 320	Nurses in hospitals
15. Najmi et al. (2018) Indonesia	To examine the effect of KM and strategic leadership on performance of hospitals	Survey n = 100	Leaders in hospitals
16. Popa et al. (2018) Romania	To investigate the impact of KM on health care system employees’ satisfaction	Survey n = 459	Health care professionals

3. Findings

The articles selected come from ten countries (USA 4, Taiwan 3, Korea 2, China 1, Indonesia 1, Nigeria 1, Kuwait 1, Turkey 1, Romania 1, and Germany 1). Most were published in 2018 (n = 3). A majority of the studies (n = 11) had adopted a quantitative approach, two had used a qualitative approach, and three were studies that used mixed methods. Ten of the articles were focused on hospitals.

3.1. Effects of knowledge management

We grouped the main findings of knowledge management effects into three main categories. The first category KM as an asset include management activities, organisational operations and financial aspects. The second category KM as a support include clinical work, patient safety and quality. The third category KM as a mediator include knowledge sharing, learning, and organisational culture.

3.1.1. Knowledge management as an asset

Knowledge management is, of course, a ubiquitous theme and important in every aspect of an organisation (Griffith et al., 2013; Tien et al., 2008). All organisations have processes for finding, sharing and developing knowledge; different processes with social and technical dimensions, are necessary to manage knowledge in health care organisations, but knowledge protocols on their own are insufficient for effective knowledge use (Orzano et al., 2008). KM can strength management activities in different way. Gowen et al. (2009) reported that KM could act of the effects of transformational leadership, and quality management and they were positively associated with three KM dimension like knowledge acquisition, knowledge dissemination and knowledge responsiveness.

Organizational operation includes the effects of KM on continuous procedural improvement and medical quality (Chang et al., 2011). KM is deeply embedded in all organisations and KM practices have wide-ranging effects from culture to process improvement to use of information technology (Griffith et al., 2013). Organizational factors affect the KM process differently in each hospital organisation. However, in hospitals, the need is for systematic management and linkage between work processes and KM activities (Lee, 2017). Dynamic capability mediates the effects of KM on hospital activities and performance (Najmi et al., 2018). Tang (2017) reported that, the better the KM, the greater organisational effectiveness is. Knowledge acquisition practices are closely connected with hospital productivity and quality (Alajmi et al., 2016).

The financial effects of KM were examined in two Taiwanese studies. Chang et al. (2011) showed that personal understanding of KM can positively predict financial results in an organisation. Wu and Hu (2012) reviewed finance and patient care: they argued that hospitals’ knowledge assets and knowledge capabilities showed an ongoing process and interaction with each other. These are the basic elements for realising positive financial and patient care effects.

3.1.2. Knowledge management as a support

Good patient-centred teamwork is affiliated with better knowledge integration, and of course the integration of the diverse knowledge of health care professionals is necessary precondition for effective teamwork (Körner et al., 2016). KM strategies have significant effects on continual operational procedure improvements. Understanding KM can predict patient, financial, learning, growth, and internal business processes (Chang et al., 2011). Wu and Hu (2012) reviewed knowledge capabilities and showed that they are the major drivers for the redesign of various hospital processes.

Research findings from Kuwaiti hospitals showed that knowledge management practices – including capturing, sharing, and generating information administered by doctors – have positive a relationship with quality and productivity (Alajmi et al., 2016). The research by McFadden et al. (2014) supports the assertion of a positive relationship between KM capabilities and quality initiatives in health care. Good KM capabilities advance the relationship of quality initiatives with patient safety learning outcomes. KM and quality management together leads to more effective use of hospital resources. It has always been suspected that KM supports patient safety in hospital: now the link seems certain as a positive significant correlation between KM applications and patient safety was found (Ocak et al., 2015).

3.1.3. Knowledge management as a mediator

Knowledge management practices were found to have processes and tools for finding, sharing, and developing knowledge and also implementing expensive technologies such as electronic medical records (Orzano et al., 2008), and internal websites (Tien et al., 2008). Griffith with her research team (Griffith et al., 2013) brought up that these health care organisations have developed KM processes throughout the organisation have effort to keep all relevant knowledge at every worker. In contrast, Orzano et al. (2008) showed that KM processes and tools were used very well by individuals but were not integrated throughout the organisation they studied. A assessments of knowledge integration have also revealed significant differences between health care professional groups (Körner et al., 2016). Knowledge acquisition and knowledge utilisation have positive effects on employee satisfaction (Popa et al., 2018).

Understanding KM can positively predict learning and growth (Chang et al., 2011), while organisational learning could support achievement of sustained health care growth through promotion of continuous learning, education, and job training (Lee et al., 2014). Tang (2017) reported that KM has a significant influence for the better on organisational culture and effectiveness: in other words, the better the KM, the greater the organisational effectiveness. Good organisational culture predicts higher organisational effectiveness, but there is a negative correlation between organisational culture and patient safety (Ocak et al., 2015).

3.2. Performance of knowledge management

We grouped the main findings of KM performance in two categories. The first category general performance of knowledge management include organisational and financial performance. The second category practical performance of knowledge management include patient and employees’ performance.

3.2.1. General performance of knowledge management

Tang (2017) showed a positive correlation between knowledge management and organisational performance; there is also a positive correlation between organisational culture and organisational performance. The research by Gowen et al. (2009) tested the degree to which KM could act as a contributor of the transformational leadership and quality management. The study showed that the effects of transformational leadership on organisational performance was fully mediated through knowledge responsiveness. Quality management contributes to increased hospital performance both directly and indirectly through its impact on increasing knowledge responsiveness. The organisational learning culture, knowledge production, and knowledge distribution in KM supports performance in health care (Chang et al., 2011). Research between KM and outcomes of nursing performance showed that a knowledge-sharing culture and deeply rooted organisational learning are the core factors affecting nursing performance (Lee et al., 2014).

Financial performance include the idea of “hard” performance, i.e., performance that is quantifiable and measurable. High levels of understanding knowledge management predicts good performance in an organisation, and KM directly reflects tangible financial performance (Chang et al., 2011); in fact, all KM activities can be assessed in terms of cost and effectiveness (Griffith et al., 2013). Organizational learning, knowledge production, and knowledge distribution in KM has a significantly positive influence on financial performance (Tang, 2017). Wu and Hu (2012) found that knowledge assets and capabilities are the basic elements for competent financial performance. KM-enabled performance is defined to include financial performance. Dynamic capabilities can act as a mediation variable in the relationship between KM on the performance of a hospital. Good levels of KM predict high performance if the mediated dynamic capability is also high (Najmi et al., 2018).

3.2.2. Practical performance of knowledge management

Knowledge management assets and capabilities are the basic elements to evaluating patient performance, but these must be nurtured for a long time before they show up in a hospital’s performance (Wu & Hu, 2012). The KM process leads to better decision making, greater efficiency and effectiveness, improved patient satisfaction, and quality of health care; in this way KM can clearly enhance organisational performance (Orzano et al., 2008). Ocak et al. (2015) showed that KM applications and patient safety performance is a positive correlation; indeed, one of the most important elements that can improve patient safety performance in health care is KM. Their research also showed that the KM process mediates the relationship between quality improvement initiatives and patient safety learning (McFadden et al., 2014).

Lee, together with her research group (Lee et al., 2014), considered the relationship between the core knowledge management factors and outcomes of nursing performance (Lee et al., 2014). In hospital settings, KM infrastructure and processes can contribute to the performance of nursing care: in fact the connection between the dimensions of knowledge infrastructure and knowledge processes significantly influences nursing care performance (Ajanaku & Mutula, 2018). Lee (2017) compared three hospitals in terms of leadership, IT systems, truth, and collaboration. The findings suggest that collaborative culture affects knowledge creation through increasing knowledge exchange. High levels of collaboration support the KM process to set mutually shared purposes for performance (Lee, 2017). Knowledge integration is positively associated with team performance and patient-centred teamwork (Körner et al., 2016). Tien et al. (2008) described how the best aspects of the performance of KM were producing new knowledge, acquiring valuable knowledge, and applying the acquired knowledge to decision-making and work processes.

4. Summary of identified knowledge management effects and performance in health care

The examined studies show that the effects and performance of knowledge management were manifested in various ways in health care organisations. The aim of KM is to improve the functioning of health care organisations by achieving more efficient operational working. Evidently then, KM is closely linked to functions such as management, finance, patient care, quality and safety, information technology, continued improvement, and organisational culture. But the effects of KM extend also to employees’ work, their job satisfaction, learning, knowledge distribution, and productivity. These findings correspond closely to Vedung’s (1997) earlier view. A summary of our results is presented in Table 3.

Table 3. Summary to identified KM effects and performance.

KM effects associated with	KM performance appears	KM performance activity
Organization’s internalprocesses Clinical processesTeamwork functionality Patient safety Patient satisfaction Quality initiatives Operational improvements Productivity and quality ofdoctors’ work Quality of nursing care Knowledge sharing Knowledge integration Knowledge production Knowledge distribution Knowledge responsiveness Learning Employee satisfaction Organizational culture Collaborative culture Organizational effectiveness Transformational leadership	Contribute Enhance Improve Is in contact Mediate Promote Strengthen Support	Management activities Productivity-related activities Operational procedures improvement Processing of information technology Financial perspectives Financial aspects Dynamic capability Value creation process Good performance in organisation

5. Discussion

The essential value of this review lies in the attempt it made to comprehend and systematise previous heterogeneous KM effects and performance studies in health care. The approach included contemplating what kind of effects KM has achieved in health care and how KM has performed in this unique cultural and administrative setting. The literature review was limited to the years 2008–2018, a period when the study of KM became more frequent in health care research. All of the studies were cross-sectional in nature with less evidential value than longitudinal studies. Most of the studies we identified used a quantitative approach: this approach made it possible to set a hypothesis and investigate the correlation between KM and other phenomena. However, the results obtained with the quantitative research method are quite subjective and do not yet provide systematic measured knowledge on the effects of KM in health care settings.

Based on our findings, KM effects can be broken down into three main categories: KM as an asset, KM as a support, and KM as a mediator. KM performance can be broken down into two main categories: that of general performance and that of practical performance. The findings of this review broadly correspond with previous research by other authors (notably Chen et al., 2009; Vedung, 1997). The effects and performance of KM have been viewed in health care from different perspectives; indeed it is now apparent that the literature of KM in health care does not form a structured and coherent body of research – a significant drawback. We observed that the same research areas were raised in the study of KM effects and KM performance. This lends support to our initial view, that it is more than justified to look at both of these perspectives at the same time. In health care, it is possible to achieve different KM effects with the same approaches and contributions.

We support Shahmoradi et al. (2017), who argue that KM is ubiquitous and linked to other management practices and operational activities in health care. KM is working as asset, as support, and as mediator, and it is an important part of all management activities, albeit it is difficult to demonstrate conclusively this connection. Other management practices can reinforce some KM dimensions, such as knowledge acquisition, knowledge dissemination, and knowledge responsiveness. This can in turn improve communication, clinical competence and quality of care.

Knowledge has a central role in health care operations (Sandhu et al., 2011), but many differing knowledge needs make practical KM difficult to achieve in health care settings. KM can help managers at different levels of the organization structure the knowledge needed for effective management. Additionally, KM can improve communication and ease the knowledge sharing tensions that can arise between different professionals. (Van Beveren, 2003; McCracken & Edvards, 2017) Interest in examining the effects and achievements of KM has grown in health care, but based on this review the perceived effects are still quite modest, and it can be difficult to separate them from other management activities.

Our research findings also emphasise the importance of KM in health care financial performance (Chen et al., 2009). The impact of KM on health care finances was highlighted in several of the reviewed studies. However, the emphasis on finance in health care KM research still remains rather slight compared to KM studies conducted in other business sectors (Inkinen, 2016). Perhaps this is because in health care the emphasis is on the acutely sensitive issues of life and death, which are a constant presence in the work of many health care professionals. However, KM could be used significantly more than at present to improve the financial performance of health care: understanding the effects of KM in improving financial performance would increase the sector’s ability to cope with the ever-increasing financial pressures which it faces. This research also has implications for future research, which should aim to be testing KM financial performance in health care with more innovative and longitudinal research techniques.

Following earlier research (McCracken & Edwards, 2017; Radević et al., 2021; Tang, 2017; Van Beveren, 2003), we argue that, the separate examination of KM in health care is fully justified for many different reasons. Health care includes special legal, ethical, and moral obligations. Furthemore, hierarchical arrangements, distinct organisational cultures, border fences between professions, and tensions related to knowledge sharing complicate the application of KM in health care structures. In our review KM seems to be one of the most important elements that can improve patient safety and quality (Candra & Putrama, 2018). KM can assist clinical work by supporting the maintenance and renewal of particular facets of knowledge related to patient care and customer service (Vedung, 1997). Patients also benefit from continued improvement of clinical processes and patient-centred teamwork. KM can also support better utilisation of knowledge generated by patients themselves; at the moment, feedback from patients in health care is not sufficiently utilised in organisational operations.

Currently, KM processes worked through by individuals are easier to organise than disseminating KM processes throughout an organisation. The positive effects of KM are, however, seen in the sharing of knowledge and in ensuring the availability of up-to-date knowledge needed by different professional groups in their work. This supports continuous improvement in heath care operations, and is one of the key factors in assessing the future success and overall performance of health care organisations. In the light of the studies assessed in this review, KM can be used to influence the attractiveness of work, the availability of the workforce, and well-being at work in health care setting. The ongoing development of information technology will enable the continuing transfer of routine knowledge processing from human to computer, and advance the utilisation of knowledge in many different ways in health care. This in turn will lead to a new way of organising the work of different professional groups and learning in the health care workplace.

In almost all of the studies reviewed, the effects and performance of KM were considered from a positive perspective; only a few of the studies highlighted any negative effects. The discussion about KM effects and performance provides clues as to the nature of the transition to a modern health care organisation where knowledge sharing is not only defined as transmitting knowledge – the wider effects and performance of KM are also considered. This review clearly shows that KM has a role in the whole range of management activities; it can strengthen the foundations of management and thus improve management in health care and other areas.

5.1. Validity, reliability and limitations

Several test searches were made with different search terms, and the final search terms were selected in consultation with an information specialist. Searches were conducted in six databases and MeSH terms were used. All of the papers considered were published in English, and this might have caused some publication bias; however, the studies originated from ten different countries (nine of which use English as a second language), which arguably decreases possible bias to at least some extent. Two of the articles ostensibly focused on KM outcomes in fact described the KM process: we excluded these articles from the study because the concept of KM effects brought up the same things. All selections were discussed and agreed together by the authors, and the selection process was carefully documented. The original articles were included in a table for quick reference and ease of interpretation. Criteria from the JBI Critical Appraisal Checklist were used in assessing the articles (Lockwood et al., 2015). Most of the research for the articles was conducted at the local level in different hospitals. Only a small number of the articles describe the role of KM effects and performance in health care.

6. Conclusions

The possibilities for the productive use of KM are still largely unused in health care settings, although the effects and performance of KM are clearly felt in health care finance, different areas of health care management, quality and safety of patient care, and in the different ways in which health care employees work, learn, and find knowledge. This review shows that KM is positively correlated to many different factors in health care. However, there is still a need to look more deeply at the relationship between KM effects and performance and different phenomena in health care organisations: more research and above all systematic measurement is needed, especially in relation to different management levels and the various complex processes and financial aspects that are present at those levels.

Disclosure statement

No potential conflict of interest was reported by the author(s).