Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England

Kathrin Cresswell,Sally Eason,Bryony Dean Franklin,Kathy Mason,Wendy Lane,Hung The Nguyen,Aziz Sheikh,Hajar Mozaffar,Marta Krasuska,Henry Potts,Robin Williams,Susan Hinder

doi:10.2196/23372

Abstract

BackgroundThe English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service.ObjectiveThis study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge.MethodsWe conducted a formative qualitative evaluation of the GDE program. We used semistructured interviews with clinical, technical, and managerial staff; national program managers and network leaders; nonparticipant observations of knowledge transfer activities through attending meetings, workshops, and conferences; and documentary analysis of policy documents. The data were thematically analyzed by drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software, to facilitate coding.ResultsWe conducted 341 one-on-one and 116 group interviews, observed 86 meetings, and analyzed 245 documents from 36 participating provider organizations. We also conducted 51 high-level interviews with policy makers and vendors; performed 77 observations of national meetings, workshops, and conferences; and analyzed 80 national documents. Formal processes put in place by the GDE program to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective when supported by informal networking. The benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas.ConclusionsKnowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological setting and goals. Policy interventions need to enhance incentives and reduce barriers to sharing across the ecosystem, be flexible in tailoring formal interventions to emerging needs, and promote informal knowledge sharing.

Highlights

BackgroundDigital transformation is central to most health system strategies, as governments around the world seek to address the challenges associated with demographic shifts and the need for sustainable care provision to aging populations with complex long-term conditions [1,2]
Knowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological setting and goals
Our exploration of interorganizational knowledge transfer in the Global Digital Exemplar (GDE) program shows that the program has made a major contribution to the current upsurge in knowledge transfer across the National Health Service (NHS)

Summary

Introduction

Policy makers and implementers generally agree on the potential of health information technology (HIT) to improve safety, quality, and efficiency of care, strategies for procurement, implementation, and optimization vary significantly across settings [3,4,5]. Large-scale HIT-enabled transformation programs have met with varying success, and there is no agreed strategy on how best to achieve digital transformation at scale [6,7,8,9]. Interorganizational knowledge sharing is a key feature of recent initiatives to promote concerted change across multiple organizations by establishing a learning ecosystem [13,14]. Understanding interorganizational knowledge transfer may help to mitigate risks by avoiding repetition of mistakes, thereby saving money and minimizing potential threats to patient safety and quality of care. The English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service

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