Theory Of Organizational Knowledge Creation Research Articles

Opening learning spaces to create actionable knowledge for conservation

AbstractThe limited application of science to environmental management has been termed the “science‐management knowledge gap.” This gap is widely assumed to be a consequence of inefficient knowledge transfer from science to application. However, this metaphor misrepresents knowledge as a “thing” that can be readily exchanged in complex systems, rather than a “process of relating” that involves negotiation and dialogue among stakeholders. We advocate for development of a more explicit alternative model of knowledge creation founded on Nonaka's Theory of Organizational Knowledge Creation, which emphasizes how knowledge is converted into more usable forms through socialization, externalization, combination, and internalization within “learning spaces.” Effective learning spaces require sufficient trust to enable open, honest, and receptive interactions among stakeholders. We advocate that greater emphasis on knowledge conversions within effectively designed learning spaces will accelerate development of actionable knowledge beyond that of existing models.

The Effect of Interactivity between KIBS Firms and Customers on Innovations in KIBS Firms

In today’s dynamic and hypercompetitive business environment, knowledge and innovation have emerged as bases for sustained competitive advantage. This paper addresses two specific research questions. First, we ask, “What is the effect that firm interactivity has on various types of innovation?” As we address this question, we explain that interactivity helps firms create knowledge, which then promotes and enables innovation. Second, we ask, “How do the various types of innovation impact firm performance?” We develop a research model and a set of hypotheses from the basis of organizational knowledge creation theory and the knowledge-based view of the firm. We test this model using survey data, and find that interactivity is positively associated with innovation. We also find that several types of innovation, including service innovation, process innovation, and organizational innovation have a positive impact on firm performance.

A cross‐level analysis of organizational knowledge creation: How do transformational leaders interact with their subordinates' expertise and interpersonal relationships?

AbstractDrawing on organizational knowledge creation theory, this study examined the associations of organizational knowledge creation with employee expertise and quality of interpersonal relationships. It also examined the moderating roles of transformational leadership in explaining these relationships. Hierarchical linear modeling was performed to analyze multilevel data collected from 218 employees across 44 teams in diverse U.S. organizations. The study results indicated that employee expertise, quality of interpersonal relationships, and transformational leadership are positively associated with organizational knowledge creation. Unexpectedly, a negative moderating role of transformational leadership was found when explaining the relationship between organizational knowledge creation and quality of interpersonal relationships. It showed no moderating effect of transformational leadership in explaining the organizational knowledge creation and employee expertise relationship. The findings improve our understanding of organizational knowledge creation and enabling conditions and provide meaningful insights into the role of transformational leadership interacting with relationships in teams. The implications of these findings for research and practice are also discussed.

The Double-Edged Sword of Servitization in Radical Product Innovation

Although servitization literature has identified the difficulties in combining products with services to improve firm performance, it has offered limited insight into the effects of servitization on radical product innovation performance. To address this gap, in this study we investigate how servitization affects radical product innovation performance through latent needs identification. Based on organizational knowledge creation theory and social structural embeddedness theory, we proposed four hypotheses and tested them with data from 208 Chinese manufacturing firms. The results show that servitization enables a firm to identify latent customer needs, and thus helps the firm to exploit more radical product innovation opportunities. However, a high degree of servitization can lead to an overembedded customer relationship, which reduces the firm’s willingness to capture such opportunities. Furthermore, we find that the overall effect of servitization on radical product innovation performance is inverted U-shaped. Our findings enrich the servitization literature by identifying two roles of servitization in radical product innovation performance.

Innovation Practices Using AI technology: Exploring Human-Machine Knowledge Conversion

The use of AI in innovation practices creates a conundrum for knowledge creation theory. Current AI technology possesses the ability to engage with data in ways that differ from the original design due to their response to contextual input data. AI may be said to embody tacit knowledge as it evolves and learns about the human collaborator and the organisational and technological context. We explore knowledge conversion involving human and AI to understand the process of digital innovation starting from the mutually constituted innovation agency. We articulate a process model of knowledge creation extending Nonaka’s seminal SECI model starting with a sociomaterial lens on knowledge conversion and a recursive relationship between the outcome of knowledge creation and the material interactions of human and AI. Our analysis links characteristics of digital innovation with the potential of AI to perform skilful work or, in other words, appear to act on tacit knowledge. This insight contributes to the literature on digital innovation a missing link for seeing material agency as intermingled with human agency and to organizational knowledge creation theory the possibility of the machine becoming part of a team. We discuss theoretical and practical implications of our study for the economics of digital innovation and suggest avenues for future research.

Revisitando a Teoria da Criação do Conhecimento Organizacional

A teoria da criação do conhecimento organizacional apresentou ampla aceitação e impacto nos meios acadêmico e profissional, quando foi publicada há mais de duas décadas, condição esta que se manteve ao longo dos anos. Conceitualmente, ela considera duas dimensões, epistemológica e ontológica, para abordar como ocorre a criação do conhecimento nas organizações. Contudo, desde sua publicação, o contexto em que as organizações estão inseridas sofreu profundas transformações, notadamente no que se refere à produção e disseminação de informação, tendo como base os avanços das tecnologias da informação e comunicação (TIC). O objetivo deste artigo foi revisitar a teoria de criação do conhecimento organizacional, enfatizando o papel da informação, enquanto conhecimento inscrito, e das TIC no apoio à criação do conhecimento nas organizações. De modo geral, os resultados apontaram para uma vasta aplicação das TIC na promoção do conhecimento e uma ascensão dos recursos tecnológicos rumo aos níveis de informação e conhecimento no âmbito organizacional.

Understand the Dynamic Theory of Organizational Knowledge Creation

After the Wars, it was necessary the companies reinvented their process and for this to create a new perspective including products and services. In 1986, Ikujiro Nonaka and Hirotaka Takeuchi received a challenge to describe product development in Japan companies. The result was “The new new product development game”. After that, Nonaka and Takeuchi wrote about their observations in this process and published many articles, presenting in 1994 the Theory of Organizational Knowledge Creation. In this context, the aim of this study is to review the Nonaka and Takeuchi documents, building a timeline and understand the concepts and the future for the Theory of Organizational Knowledge Creation. Firstly, we search the articles from Nonaka in the Scopus database. Secondly, we started reading the article “Dynamic Theory of Organizational Knowledge Creation” published in 1994 for Nonaka. Based on their references we returned for the search results and read the articles. Next, we read the articles published after 1994 and comprehending their link with the Theory of Organizational Knowledge Creation. Although the Theory of Organizational Knowledge Creation is recognized and diffused in the academy and in the organizations that study or implant the Knowledge Management, it is noticed that few authors deepen the knowledge to understand the fundamentals of the theory or, of fundamental reasoning. It is evident the concern of Nonaka and his co-authors to seek facilitators for the modes of knowledge conversion, to facilitate the practical application of the modes of knowledge conversion.

The role of human beings in the age of AI: From the view point of organizational knowledge creation theory

The role of human beings in the age of AI: From the view point of organizational knowledge creation theory

Creating knowledge and promoting innovation in logistics services with “personal-touch”: a case of Yamato transport

ABSTRACT“TA-Q-BIN” parcel delivery service by Yamato Transport Co., Ltd (hereafter Yamato Transport) is regarded equivalent to a social infrastructure in Japan. Since its start in 1976, Yamato Transport has extended services’ reach and volume, realising nationwide coverage in 1997 and achieving around 30 billion accumulated deliveries by the end of March 2017. Behind this achievement is the company’s continuous innovation of their service offerings not only by enhancing its digital information systems and its physical logistic networks but also by keeping analogue “personal-touch” and improving the service beyond customers’ expectation. Personal touch at the point of delivery triggers new knowledge which becomes the source of competitiveness. Grounding on the organisational knowledge creation theory, this paper aims to explain how Yamato Transport was able to enhance competitive advantage through creating new knowledge by pursuing both the “personal-touch” and the digitalisation, and ultimately realising innovation, and ultimately co-creating value for the society.

Theoretical Approaches to Studying Psychological Ensuring of Personnel Management in Scientific Organizations

Introduction. The paper addresses the issue of psychological ensuring of personnel management in Russian scientific organizations. For the first time, the types of scientific organizations in the Russian Federation are analyzed to account for their opportunities and limitations of employing existing international techniques for personnel management under the conditions of growing globalization and informatization in the field of research activities.
 Theoretical Basis. When choosing a theoretical approach for psychological ensuring of personnel management, it is important to take into consideration the type of scientific organization in terms of its research activities (theoretical/applied), form of financing (budget/commercial/mixed), and the place the research activities occupy among a researcher’s professional responsibilities (central/peripheral).
 Results. The study reviewed the following theories and theoretical models: the model of the peaks of a scientist’s creative productivity (G. J. Feist), the model of gift economy in the field of research activities (K. Vermeir), and various hybrid models. According to the study analyses, the concept of motivation for scientific activity (T. V. Razina) can be instrumental in assessing the role of ten types of motivational subsystems when carrying out research activities and developing the means of stimulating them. The study concentrates on the following theoretical models for establishing creative environments: (a) the dynamic theory of organizational knowledge creation (I. Nonaka and colleagues) that is applicable for any organization and (b) the model of creative environments for the research process in academic circles or commercial research laboratories suggested by A. P. Wierzbicki and Y. Nakamori. The paper also analyses certain characteristics of virtual organizations that determine specific aspects of personnel management process and reflects on particular models for its implementation.
 Discussion. The theories and theoretical approaches to managing research teams, encompassed in the study were analyzed specifically in application to scientific organizations in Russia. The main obstacles for their ‘direct’ use there lie in ethnic, national, and specific cultural characteristics of Russian research facilities, limited use of information technology, and the lack of socio-economic and political stability in the country.
 Highlights
 
 Cultural and historical specificity, as well as the vast variety of types of scientific organizations in Russia, determine the need for the development and considerable modification of the existing methods and techniques for personnel management.
 Gradually establishing creative environments in Russian research teams that would take into their specific characteristics has a great potential for the practice of personnel management.
 Carrying out empirical studies on creative productivity – its peaks and the factors that determine them (e.g., age, academic degree) is important for psychological ensuring of personnel management in Russian scientific organizations.

Positive emotion in knowledge creation

PurposeDespite the importance of evidence-based practice, the translation of knowledge into quality healthcare continues to be stymied by an array of micro, meso and macro factors. The purpose of this paper is to suggest a need to consider different – if not unconventional approaches – like the role of positive emotion, and how it might be used to promote and sustain knowledge translation (KT).Design/methodology/approachBy reviewing and coalescing two distinct theories – the broaden-and-build theory of positive emotions and the organisational knowledge creation theory – this paper presents a case for the role of positive emotion in KT.FindingsTheories pertaining to positive emotion and organisational knowledge creation have much to offer KT in healthcare. Three conceptual “entry points” might be particularly helpful to integrate the two domains – namely, understanding the relationship between knowledge and positive emotions; positive emotions related to Nonaka’s concept of knowledge creation; and the mutual enrichment contained in the parallel “upward spiralling” of both theories.Research limitations/implicationsThis is a conceptual paper and as such is limited in its applicability and scope. Future work should empirically explore these conceptual findings, delving into positive emotion and KT.Originality/valueThis is the first paper to bring together two seemingly disparate theories to address an intractable issue – the translation of knowledge into quality healthcare. This represents an important point of departure from current KT discourse, much of which continues to superimpose artefacts like clinical practice guidelines onto complex healthcare context.

Propuesta metodológica para incorporar la creación del conocimiento a los sistemas de gestión en las entidades del Estado del nivel nacional

<p>El Estado colombiano definió los sistemas de gestión de calidad y control interno como herramientas de gestión de obligatoria implementación bajo los referentes de la Norma Técnica de Calidad en la Gestión Pública y el Modelo Estándar de Control Interno. Posteriormente, en pro del mejoramiento continuo de la administración pública y de la mejora de la gestión, se especificaron lineamientos adicionales asociados a las políticas de desarrollo administrativo, los cuales generaron en las entidades públicas la incorporación de requerimientos que impactan estos sistemas produciendo desgastes administrativos, fallas en el control de los procesos, desinformación y sobrecostos, entre otros. Este proyecto de investigación buscó crear una propuesta metodológica que permita a los entes gubernamentales nacionales incorporar algunos conceptos como políticas, requerimientos, temas o componentes (entre otros significados) a sus modelos de gestión de calidad y normas de control interno realizados previamente y basados en esos modelos. Por lo anterior, analizada la Teoría de Creación del Conocimiento Organizacional de Nonaka y Kakeuchi, frente a los sistemas de gestión de calidad y control interno aplicables a las entidades del Estado colombiano del ámbito nacional, se identificó un vínculo que reconoce la existencia de condiciones que facilitan el flujo del conocimiento a través de la socialización entre individuos y organizaciones, toda vez que se establecen lineamientos que propician, regulan, justifican y promueven la generación de nuevos conceptos, para incorporarlos a la gestión institucional. Definida la propuesta, se realizó un ejercicio de validación en la ANLA para incorporar el objeto de conocimiento “participación ciudadana y control social” a sus sistemas y se estableció que la articulación de las fases de creación del conocimiento organizacional con los sistemas de gestión, facilita la incorporación de nuevos objetos de conocimiento garantizando la integridad de los sistemas ya implementados.</p>

Technology-Enhanced Knowledge Management Framework for Retaining Research Knowledge among University Academics

Given the challenge of retaining the research knowledge of an aging, experienced professoriate at South African Universities of Technology, institutions with a nascent tradition of scholarly research, this paper explores the feasibility of a technology-enhanced knowledge management framework for generating, sharing and retaining tacit research knowledge to leverage research outputs at the Central University of Technology (CUT), Free State, South Africa. Since digital trails of established-novice researcher interactions are left behind whenever they interact in online platforms, an examination of such interactions can provide insights into the sharing and transferring of tacit research knowledge from senior researchers to novices. This theoretical study draws on Nonaka and Takeuchi’s Theory of Organisational Knowledge Creation, an emerging technology platform, SharePoint, mainstream literature and the authors’ reflective experiences to develop a technology-enhanced knowledge management model. The paper argues that tacit knowledge can be assimilated from a comprehensive examination of the knowledge production interactions between senior academics and novices enabled by low threshold technology and collaborative sharing of content. This study’s insights are relevant to Higher Educational Institutions (HEIs) struggling to create a sustainable culture of scholarly research and grow a new generation of competent researchers amid the attrition of senior academics and the prevalence of systemic blockages in knowledge transfer processes.

Technology-Enhanced Knowledge Management Framework for Retaining Research Knowledge among University Academics

Given the challenge of retaining the research knowledge of an aging, experienced professoriate at South African Universities of Technology, institutions with a nascent tradition of scholarly research, this paper explores the feasibility of a technology-enhanced knowledge management framework for generating, sharing and retaining tacit research knowledge to leverage research outputs at the Central University of Technology (CUT), Free State, South Africa. Since digital trails of established-novice researcher interactions are left behind whenever they interact in online platforms, an examination of such interactions can provide insights into the sharing and transferring of tacit research knowledge from senior researchers to novices. This theoretical study draws on Nonaka and Takeuchi’s Theory of Organisational Knowledge Creation, an emerging technology platform, SharePoint, mainstream literature and the authors’ reflective experiences to develop a technology-enhanced knowledge management model. The paper argues that tacit knowledge can be assimilated from a comprehensive examination of the knowledge production interactions between senior academics and novices enabled by low threshold technology and collaborative sharing of content. This study’s insights are relevant to Higher Educational Institutions (HEIs) struggling to create a sustainable culture of scholarly research and grow a new generation of competent researchers amid the attrition of senior academics and the prevalence of systemic blockages in knowledge transfer processes.

Inter-organisational learning among health care professionals: A learning arena to address transitional care of the elderly

Introduction : The study reports findings from an inter-organisational learning arena, the “Meeting Point”, designed to address transitional care of the elderly across care levels (admissions, discharge). The aim of the study was to reveal how the “Meeting Point” enables inter-organisational learning across primary and specialist healthcare services. The background for establishing the “Meeting Point” was findings from an exploratory study documenting the need for an arena for health professionals across care levels to be able to discuss issues and responsibilities related to the quality of transitional care (Aase et al, 2013; Storm et al, 2014). Methods/Theory : The study design is qualitative and descriptive, using participant observation as data collection method. About one hundred health care professionals from hospital and municipality healthcare services attended the “Meeting Point”. The “Meeting Point” seminars consisted of three main phases, Mingling, Dissemination, and Dialogue, related to transitional care of the elderly. An observation guide was developed based on theories of knowledge creation and inter-organisational learning (Nonaka & Takeuchi, 1995; Nonaka, 1994; Easterby-Smith et al, 2008). The guide was tested during four “Meeting Point” sessions in 2013, revised and used for data collection during three “Meeting Point” seminars in January 2014. Results : The “Meeting Point” arena enabled four forms of knowledge interaction among healthcare personnel across care levels and professions; socialization (the process of creating tacit knowledge through shared experience), externalization (the conversion of tacit knowledge into explicit knowledge), combination (creating explicit knowledge by combining different bodies of explicit knowledge) and internalization (the conversion of explicit knowledge into tacit knowledge). The interaction forms varied in different phases of the learning arena. Socialization was enabled by unrestricted time, films, shared meals, informal discussions, and a meeting location separated from the participating units’ surroundings (present in Mingling and Dissemination phases). Externalization was enabled by PowerPoint presentations, lectures, group discussions, participants seated in small groups, and participants’ formulation of written measures (present in Dissemination and Dialogue phases). Combination was enabled by setting aside time and arranging for informal discussions, summary of already existing knowledge, PowerPoint presentations, group discussions, participants seated in small groups and participants’ formulation of written measures (present in Mingling, Dissemination, and Dialogue phases). Internalization was enabled by means of lectures, opportunity for questions and reflections, group discussions and participants seated in small groups (present in Dissemination and Dialogue phases). Inter-organisational learning at the “Meeting Point” was further strengthened by inter-organisational dynamics (i.e. facilitating informal discussions, time available, opportunity for social contact, gathering the same participants in several sessions over time, lectures, opening up for questions from the participants, film, group discussions, and the presence of facilitators) and characteristics of the participants (i.e. participants motivated to learn and share knowledge, recognition of the value of new knowledge, and valuable knowledge). Discussion : The study results describe how the establishment of a learning arena can facilitate important knowledge interaction related to transitional care of the elderly across care levels, thus addressing a vital component of integrated care, i.e. the ability to meet across organizational and professional boundaries. The literature shows a lack of current studies proposing methods to support knowledge interaction in health care, in which this study contributes. To implement the “Meeting Point” as an integral part of current work practices in transitional care of elderly patients involves challenges related to responsibility, organization, resources and culture. The study offers proposals for how a learning arena can be developed and implemented in practice. Conclusion : The “Meeting Point” met vital criteria for inter-organizational learning indicating that it should be considered a powerful arena to tailor knowledge interaction related to transitional care of the elderly. It is important to conduct further studies to establish the impact of the “Meeting Point” on learning conditions in the participating health care units and the quality of transitional care of the elderly. References : 1- Aase, K., Laugaland, K. A., Dyrstad, D. N., & Storm, M. Quality and safety in transitional care of the elderly: the study protocol of a case study research design (phase 1); 2013. BMJ Open, 3(8). doi: 10.1136/bmjopen-2013-003506 2- Easterby‐Smith, M., Lyles, M. A., & Tsang, E. W. Inter‐organizational knowledge transfer: Current themes and future prospects. Journal of management studies; 2008;45(4):677-690. doi: 10.1111/j.1467-6486.2008.00773.x 3- Nonaka, I. A dynamic theory of organizational knowledge creation. Organization science, 1994;5(1):14-37. doi: 10.1287/orsc.5.1.14 4- Nonaka, I., & Takeuchi, H. The Knowledge Creating Company. New York: Oxford University Press; 1995. 5- Storm, M., Siemsen, I. M. D., Laugaland, K. A., Dyrstad, D. N., & Aase, K. Quality in transitional care of the elderly: Key challenges and relevant improvement measures. International Journal of Integrated Care, 2014;14(2). Available from: https://www.ijic.org/index.php/ijic/article/view/1194/2384 [20.05.14]

The Power of Unstructured Data

This study examined the incorporation of tacit knowledge into corporate business intelligence and its impact on business performance, specifically analyzing individual productivity. Business productivity in relation to the use of knowledge has been investigated but using macro-dimensions not specifically oriented to individual workers' productivity. This study was based on externalization, one of the modes in the theory of organizational knowledge creation (that is, converting tacit knowledge into explicit knowledge). The findings on the literature stated that knowledge is the most important piece of business competitive advantage and that tacit knowledge is a key part of that knowledge. This research found that tacit knowledge did not influence individual engineers' productivity and as such did not affect business performance. Additionally, it found that tacit knowledge was not a factor that could be used to predict individual productivity. This research was the first attempt to investigate individual productivity in relation to tacit knowledge.

Developing a theory-based information security management framework for human service organizations

Purpose This paper aims to identify organizations’ information security issues and to explore dynamic, organizational culture and contingency theories to develop an implementable framework for information security systems in human service organizations (HSOs) based soundly in theory and practice. Design/methodology/approach The paper includes a critical review of global information security management issues for HSOs and relevant multi-disciplinary organizational theories to address them. Findings Effective information security management can be particularly challenging to HSO because of their use of volunteer staff in a borderless electronic environment. Organizations’ lack of recognition of the need for staff awareness of information security threats and for training in secure work practices, particularly in terms of maintaining clients’ privacy and confidentiality, is a major issue. The dynamic theory of organizational knowledge creation, organizational culture theory and contingency theory were identified as the most suitable theoretical perspectives to address this issue and underpin an effective information security management framework for HSOs. Research limitations/implications The theory-based framework presented here has not been tested in practice. Such testing will be carried out in further research. Originality/value Currently, there is no framework for information security systems in HSOs. The framework developed here provides a foundation on which HSO can build information security systems specific to their needs.

How do they create ‘Superpower’? An exploration of knowledge-creation processes and work environments in the wearable technology industry

ABSTRACTWearable technology (WT) offers tremendous opportunities for growth and innovation for many of today's businesses. It presents unique challenges in organising heterogeneous productive teams from multi-disciplines. However, little is known about how these WT firms operate to facilitate innovations. Therefore, this study explored the meaning of successful WT, the knowledge-creation processes, and the work environments described by WT professionals in the USA and the Netherlands. An interpretive analysis of 16 in-depth interviews revealed that, a successful WT makes life easier by ‘making you do more with less’, and solving multiple problems, that gives ‘super power’ to human beings. The findings were mostly consistent with the organisational knowledge creation theory in that knowledge is created through socialisation by personal communication, internalisation of knowledge by experimentation, and combination by learning from and teaching other members of WT communities. A productive WT work environment was explained to be respectful and nurturing.

Neuroscience Evidence for Economic Humanism in Management Science: Organizational Implications and Strategy.

Globalization phenomena and Information Communication Technology (ICT) are producing deep changes worldwide. The economic environment and society where firms both cooperate and compete with each other are rapidly changing leading firms towards recognizing the role of intangible resources as a source of fresh competitive advantage. Experience, innovation and the ability to create new knowledge completely arise from the act of human resources inviting firms to focus on how to generate and shape knowledge. Therefore, the future of firms depends greatly on how managers are able to explore and exploit human resources. However, without a clear understanding of the nature of human beings and the complexity behind human interactions, we cannot understand the theory of organizational knowledge creation. Thus, how can firms discover, manage and valorize this "human advantage"? Neuroscience can increase the understanding of how cognitive and emotional processes work; in doing so, we may be able to better understand how individuals involved in a business organization make decisions and how external factors influence their behavior, especially in terms of commitment activation and engagement level. In this respect, a neuroscientific approach to business can support managers in decision-making processes. In a scenario where economic humanism plays a central role in the process of fostering firms' competitiveness and emerging strategies, we believe that a neuroscience approach in a business organization could be a valid source of value and inspiration for manager decision-making processes.

Relationship‐centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care

Contemporary health care is increasing in complexity and lacks a unifying understanding of epistemology, methodology and goals. Lack of conceptual consistency in concepts such as 'patient-centred care' (PCC) typifies system-wide discordance. We contrast the fragmented descriptions of PCC and related tools to its own origins in the writings of Balint and to a subsequent construct, relationship-centred care (RCC). We identify the explicit and elaborated connection between RCC and a defined epistemological foundation as a distinguishing feature of the construct and we demonstrate that this makes possible the recognition of alignments between RCC and independently developed constructs. Among these, we emphasize Schon's reflective practice, Nonaka's theory of organizational knowledge creation and the research methodology of realist synthesis. We highlight the relational principles common to these domains and to their common epistemologies and illustrate unsatisfying consequences of adherence to less adequate epistemological frameworks such as positivism. We offer RCC not as an 'antidote' to the dilemmas identified at the outset but as an example that illuminates the value and importance of explicit identification of the premises and assumptions underlying approaches to improvement of the health care system. We stress the potential value of identifying epistemological affinities across otherwise disparate fields and disciplines.