The strategic management of organizational knowledge exchange related to hospital quality measurement and reporting

CONTEXT/PURPOSE: With the growing momentum toward hospital quality measurement and reporting by public and private health care payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding accuracy. This study explores the relationship between the organizational knowledge-sharing structure related to quality and hospital coding accuracy for quality measurement. Simultaneously, this study seeks to identify other leadership/management characteristics associated with coding for quality measurement. THEORY AND METHODS: Drawing upon complexity theory, the literature on "professional complex systems" has put forth various strategies for managing change and turnaround in professional organizations. In so doing, it has emphasized the importance of knowledge creation and organizational learning through interdisciplinary networks. This study integrates complexity, network structure, and "subgoals" theories to develop a framework for knowledge-sharing network effectiveness in professional complex systems. This framework is used to design an exploratory and comparative research study. The sample consists of 4 hospitals, 2 showing "good coding" accuracy for quality measurement and 2 showing "poor coding" accuracy. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. FINDINGS AND IMPLICATIONS: Findings of this study indicate that good coding performance is systematically associated with a knowledge-sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment), rather than in density (where everyone is directly connected to everyone else). It also implies that for the hospital organization to adapt to the changing environment of quality transparency, senior leaders must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and connect these subgroups with the changing external environment.