A micro-macro sense-making model for knowledge creation and utilization in healthcare organizations

  • Louisa Mei Chun Lam

Student thesis: Doctoral ThesisDoctor of Philosophy


The purpose of this research is to study how new knowledge is created, used, and shared at both micro- and macro- levels in healthcare organizations so as understand how this can improve evidence-based practice and provide new roles for information professionals to better EBM and clinical decision-making. Using Dervin’s SMM as the primary research framework, supplemented with Snowden’s Cynefin Framework for data analysis, the results demonstrated that individual knowledge was created in the gap-bridging process as the sense-making moment. Situation movement state and gap-bridging strategies were two predictors for knowledge creation. The knowledge gaps were identified and a wide range of gap-bridging strategies were employed to cross the gaps and create new knowledge. This micro process of knowledge creation is linked to the organizational level thorough knowledge sharing. This whole process of knowledge creation, utilization and sharing were mapped into a new micro-macro sense-making model, showing all the barriers and enablers identified in this research. These findings have filled the missing gaps in the literature and answered the long-standing question of how new knowledge is created in organizations. These findings would be able to shed new light to the practice of EBM. Some possible ways are to shift the attention to the use of medical knowledge, place more emphasis to the use of case-based reasoning approach, develop personalized medicine, and raise the importance of narratives in clinical practice. The new roles for information professionals in support for KM include: 1) the provision of different case-based reasoning systems; 2) use of IT tools in KM to assist clinicians to make sense of the situation; 3) taking user-centered verbing approach to organize knowledge sources; 4) building up expertise network; 5) use of narratives and storytelling for knowledge sharing; 6) engaging in virtual communities of practice; and 7) equipping library space to facilitate learning.
Date of Award18 Mar 2015
Original languageEnglish
Awarding Institution
  • Aberystwyth University
SupervisorChristine Urquhart (Supervisor) & Pauline Rafferty (Supervisor)

Cite this