37° Congresso nazionale ANMDO Bologna, 8-10 giugno 2011 Le architetture del sapere Prof. Ferdinando Romano.

37° Congresso nazionale ANMDOBologna, 8-10 giugno 2011

Le architetture del sapere

Prof. Ferdinando Romano

Knowledge of the spirit world is to be obtained by divination; information in natural science may be sought by inductive reasoning; the law of universe can be verified by mathematical Calculation

Sun Tzu, The art of war

WisdomWisdomImplicitly knowing How to Generate Access and Implicitly knowing How to Generate Access and

Integrate KnowledgeIntegrate Knowledge

KnowledgeKnowledgeValidated Platform for ActionValidated Platform for Action

InformationInformationPatterned DataPatterned Data

DataDataDispersed ElementsDispersed Elements

THE PYRAMID OF KNOWLEDGETHE PYRAMID OF KNOWLEDGE

Il disordine, il caso, l’agitazione, la

dispersione, la disorganizzazione

stessa

(2° principio della termodinamica),

sembrano parte integrante dei

processi di organizzazione del

mondo (Morin E., 1984)

AttivitàAttività

1.1.Adempimenti DGRCAdempimenti DGRC n.596 del 5 agosto n.596 del 5 agosto 20102010

2.2.Piano di riassetto della rete ospedalieraPiano di riassetto della rete ospedaliera

3.3.Piano attuativoPiano attuativo

4.4.RiqualificazioneRiqualificazione

MonitorMonitorKnowledgeKnowledge

UseUse

SustainSustainKnowledgeKnowledge

UseUse

EvaluateEvaluateOutcomesOutcomes

AdaptAdaptKnowledgeKnowledge

to Local Contextto Local Context

Assess Barriers/Assess Barriers/Supports to Supports to

Knowledge UseKnowledge Use

Select, Tailor,Select, Tailor,ImplementImplement

InterventionsInterventions

Identify ProblemIdentify Problem

Identify, Review,Identify, Review,Select KnowledgeSelect Knowledge

ProductProducts/Toolss/Tools

SynthesisSynthesis

KnowledgKnowledge Inquirye Inquiry

Tailo

ring

Kno

wle

dge

KNOWLEDGE CREATIONKNOWLEDGE CREATION

Graham et al.: The Journal of Continuing Education in the Health Professions, 2006

The knowledge cycle

Forms and Stages of Knowledge Production

Most people (professionals included) Most people (professionals included) operate most of the time as operate most of the time as automatic pilot: spending least automatic pilot: spending least amount of reflective thinking time on amount of reflective thinking time on tasks they spend most of their time tasks they spend most of their time doingdoing

Kitson, A., Strauss, S.E. (2009) Identifying the knowledge-to-action gaps, Knowledge Translation in Health Care, Wiley-Blackwell

The persistent gap between available evidence and current practice in healthcare reinforces the challenge of finding effective solutions.

Contributing to this current status have been the complexity of change process, limitations of research on implementation, and slow recognition of the critical role of organizational context

Stelter, C.B. et al. (2008) An organizational framework and strategic implementation for system-level change to enhance research-based practice, Implementation Science

Have Don’t have

Know

Esplicit KnowledgeEsplicit Knowledge

Knowledge you know you have

Knowledge gapsKnowledge gaps

Knowledge you know you don’t have

Don’t know

Tacit KnowledgeTacit Knowledge

Knowledge you don’t know you have

Unknown gapsUnknown gaps

Knowledge you don’t know you don’t have

Knowledge gapsKnowledge gaps

Knowledge transfer and exchangeKnowledge transfer and exchange: bringing : bringing together researchers and stakeholders and together researchers and stakeholders and facilitating their interactionfacilitating their interaction

Research utilizationResearch utilization: : moving research findings moving research findings into action.into action.

Implementation Implementation ResearchResearch: : the scientificthe scientific

study of methods to promote the systematic study of methods to promote the systematic uptake of clinical research findings and other uptake of clinical research findings and other evidence-based practices into routine practice evidence-based practices into routine practice and, hence, to improve the quality and and, hence, to improve the quality and effectiveness effectiveness of health care.of health care.

DisseminationDissemination: the complex process of moving : the complex process of moving research into practiceresearch into practice

Knowledge-to-action (KTA)Knowledge-to-action (KTA)

Graham et al. (2006)” Lost in Knowledge Translation: Time for a Map?” The Journal of Continuing Education in the Health Professions

Knowledge as capabilitiesUnderlines the potential of organizational structures and resources to support people in their attempts to use knowledge

Knowledge as processEmphasizes flexibility in knowledge use and the need to contextualize knowledge (plausibility, acceptability and feasibility)

Knowledge as codificationFocuses on the role of codified knowledge to govern health-care organizations

Denis, J-L, Lehoux, P (2009), Organizational theory, Knowledge Translation in Health Care

Taken together, these three building Taken together, these three building blocks reflect a constant tension blocks reflect a constant tension between the search for conformity between the search for conformity between research-based evidence and between research-based evidence and organizational practices and the need organizational practices and the need for for in-situ learning and adaptation in in-situ learning and adaptation in order to bring about quality and order to bring about quality and performance improvementperformance improvement

Denis, J-L, Lehoux, P (2009), Organizational theory, Knowledge Translation in Health Care

Explicit (formal) knowledgeExplicit (formal) knowledgeversus versus

Tacit knowledgeTacit knowledge

Have Don’t have

Know

Esplicit KnowledgeEsplicit Knowledge

Knowledge you know you have

Knowledge gapsKnowledge gaps

Knowledge you know you don’t have

Don’t know

Tacit KnowledgeTacit Knowledge

Knowledge you don’t know you have

Unknown gapsUnknown gaps

Knowledge you don’t know you don’t have

Knowledge gapsKnowledge gaps

Tacit knowledge (definition)Tacit knowledge (definition)

Knowledge that is not made explicit because it is highly personal, not easily visible or expressible, and usually requires joint, shared activities in requires joint, shared activities in order to transmit itorder to transmit it. Examples of tacit knowledge include subjective insights and intuitions.

Tacit knowledge (implications)Tacit knowledge (implications)

With tacit knowledge, people With tacit knowledge, people are not often aware of the are not often aware of the knowledge they possess or how knowledge they possess or how it can be valuable to others.it can be valuable to others.

Effective transfer of tacit Effective transfer of tacit

knowledge generally requires knowledge generally requires extensive personal contact and extensive personal contact and trusttrust. .

In any organization In any organization the goal is to the goal is to create a create a hybrid designhybrid design for its for its knowledge management practice knowledge management practice that synthesizes the “right” that synthesizes the “right” combination and combination and balance of the balance of the tacit and explicit knowledge tacit and explicit knowledge management approachesmanagement approaches..

The half-life of knowledge is decreasingThe half-life of knowledge is decreasing

The half-life of knowledge can be interpreted as the time-scale in which knowledge is replaced by new knowledge.

The half-life of ICT knowledge is already considered to be less than nine months. In medicine the “half life” of knowledge” is 3-4 years.

Does the workforce generalise or specialise?

European Commission, “Changing professions in 2015 and beyond”, 2006

Currently, the professional faces the Currently, the professional faces the increased dynamics of knowledge. increased dynamics of knowledge. The supervisor cannot reasonably be The supervisor cannot reasonably be expected to be up to date and be able expected to be up to date and be able to understand everything, when the to understand everything, when the knowledge that they use changes. knowledge that they use changes. As the half-life of knowledge decreases As the half-life of knowledge decreases this gap will increase ever further. this gap will increase ever further. To remedy this effect, it will be To remedy this effect, it will be important that the important that the supervisors become supervisors become generalists when they climb up the generalists when they climb up the ranksranks..European Commission, “Changing professions in 2015 and beyond”, 2006

Currently, a surgeon who has climbed up Currently, a surgeon who has climbed up the ranks supervises a set of surgeons.the ranks supervises a set of surgeons.

He can therefore easily switch between the He can therefore easily switch between the surgeons he supervises. surgeons he supervises.

In the future this will no longer be the In the future this will no longer be the casecase. .

The doctors he supervises become moreThe doctors he supervises become morespecialised. Their expertise focuses on one specialised. Their expertise focuses on one area. Consequently not only does the area. Consequently not only does the knowledge gap between the various knowledge gap between the various doctors increase, also the gap of doctors increase, also the gap of knowledge will increase between the knowledge will increase between the supervisor and his employees. supervisor and his employees.

A change of skills of the A change of skills of the doctors is doctors is therefore essential.therefore essential.European Commission, “Changing professions in 2015 and beyond”, 2006

The increased knowledge gap The increased knowledge gap between the various experts and between the various experts and their supervisorstheir supervisorswill necessitate a change of skills.will necessitate a change of skills.

In the future the supervisor will In the future the supervisor will have to be able to bridge the have to be able to bridge the knowledge gapknowledge gapbetween the doctors and him.between the doctors and him.Unless the skills of the supervisor Unless the skills of the supervisor change, these gaps cannot bechange, these gaps cannot bebridged.bridged.European Commission, “Changing professions in 2015 and beyond”, 2006

As knowledge becomes more dynamic As knowledge becomes more dynamic and the amount of information is and the amount of information is rising, rising, professionals in the health professionals in the health carecare sector will face a choice. sector will face a choice. They They can either can either generalise or specialise.generalise or specialise.

European Commission, “Changing professions in 2015 and beyond”, 2006

Have Don’t have

Know

Esplicit KnowledgeEsplicit Knowledge

Knowledge you know you have

Knowledge gapsKnowledge gaps

Knowledge you know you don’t have

Don’t know

Tacit KnowledgeTacit Knowledge

Knowledge you don’t know you have

Unknown gapsUnknown gaps

Knowledge you don’t know you don’t have

Knowledge gapsKnowledge gaps

Dalla conoscenza alla competenzaDalla conoscenza alla competenza

Quando possiamo dire che il soggetto possiede effettivamente una competenza?

Una competenza è sempre associata alla presenza nel soggetto di uno specifico modello mentalemodello mentale relativo a quel dato dominio.Un modello mentale è la "teoria" che guida il soggetto nelle decisioni e nelle scelte che egli compie quando si trova ad agire nel mondo. R. Trinchero in “Le risorse culturali della rete”, Milano, Franco Angeli, 2003

I soggetti che sono in grado di I soggetti che sono in grado di ristrutturare ristrutturare rapidamente ed efficacemente i propri rapidamente ed efficacemente i propri modelli mentali, e che sono aperti alla modelli mentali, e che sono aperti alla sperimentazione e accettazione di modelli sperimentazione e accettazione di modelli mentali alternativimentali alternativi in risposta agli stimoli in risposta agli stimoli che provengono dall'esterno, sono quelli che provengono dall'esterno, sono quelli che riescono meglio ad adattarsi che riescono meglio ad adattarsi all'ambiente, dato che sono in grado all'ambiente, dato che sono in grado affrontare situazioni nuove, impreviste e affrontare situazioni nuove, impreviste e complesse con decisioni maggiormente complesse con decisioni maggiormente efficaci ed efficienti (efficaci ed efficienti (teoria della flessibilità teoria della flessibilità cognitivacognitiva))

R. Trinchero in “Le risorse culturali della rete”, Milano, Franco Angeli, 2003

Nella Nella competenzacompetenza non rientra quindi non rientra quindi solo la padronanza di un modello solo la padronanza di un modello mentale adeguato ma anche la sua mentale adeguato ma anche la sua capacità di ristrutturazione in relazione capacità di ristrutturazione in relazione agli eventi contingentiagli eventi contingenti. Questo è uno . Questo è uno degli elementi che contraddistingue il degli elementi che contraddistingue il comportamento comunemente definito comportamento comunemente definito intelligenteintelligente: il fatto di non rimanere : il fatto di non rimanere fermi ad oltranza sulle proprie posizioni fermi ad oltranza sulle proprie posizioni ma di sintonizzarsi di volta in volta sulla ma di sintonizzarsi di volta in volta sulla specifica situazione.specifica situazione.

R. Trinchero in “Le risorse culturali della rete”, Milano, Franco Angeli, 2003

Dilbert’s theorem on salary (by Scott Adams)

Enunciato : Ingegneri e scienziati non guadagneranno mai quanto i commercianti e gli uomini d’affari

Dimostrazione

Postulato 1: il Sapere è Potere (Sapere = Potenza)Postulato 2: il Tempo è Denaro (Tempo = Denaro)In fisica: Potenza = Lavoro/Tempo

Sostituendo abbiamo: Sapere = Lavoro/Denaro

Quindi Denaro = Lavoro /

SapereQuando il Sapere tende a zero, il Denaro tende a infinito, indipendentemente dal lavoro svolto.

Conclusion: The Less you Know, the More you Conclusion: The Less you Know, the More you Make.Make.