Social Analysis of Emergent
Medical Service in the Netherlands
School of Information System and Technology
Faculty of Informatics, University of Wollongong, Australia
Emergent Medical Service （EMS） in the Netherlands has experienced difficulties in saving acute myocardial infarction (AMI) patients’ lives by avoiding delay for treatment. The problem was associated with various weaknesses of the service system, which included (1) delay of patient (i.e., the patients did not contact their GP or EMS when the AMI occurred), (2) delay of GP (i.e., it took some time for the patients to see a GP and it took some time for the GP to diagnose the patients and decide to redirect them to EMS), and (3) delay of treatment (i.e., when the patients were delivered to the hospital, they might not receive treatment immediately) (He 2009).
As a result, a new solution proposed by EMS was to allow citizen to call EMS directly. An alternative solution proposed by He (2009) is to develop a priority service system for AMI patients and only let this kind of patients bypass the GP. In He (2009), the service processes within EMS has been analysed through a CommonKADS framework (Schreiber et al. 2000), but some theoretical and practical issues were not covered under the CommonKADS framework and still left unsolved. This paper will use another two frameworks to analyse the unsolved issues associating with the implementation of the solution by He (2009) from a social perspective.
2 Issues Identified
2.1 Absence of Systematic Analysis
CommonKADS can help identify key processes, knowledge, and problems within an organisation. However, this approach looks into the organisation from a general dimension gradually to more and more specific aspects. It can not provide us with a more systematic view of the organisation. If a problem is only rooted in one position or one task within the processes, then CommonKADS may be a good method to locate and analyse that particular point. For example, Task 2 Emergency Assessment by dispatchers was identified as problematic in OM-3 within the CommonKADS framework and then OM-4, TM-1 and AM-1 further detailed the knowledge asset and the agent involved in Task 2 (He 2009). The implementation of the new solution led by such findings within CommonKADS framework may ignore the factors from other departments of the organisations (e.g., Ambulance Service and AMI professionals) as well as from outside of EMS (e.g., GP, public media, etc.). In other words, the result from the CommonKADS analysis indicates that the focus for further action should be on Task 2 Emergency Assessment. However, this is obviously insufficient for developing a priority service for AMI patients.
2.2 Absence of Guidance on Implementing the New Solution
Although CommonKADS analysis of the EMS case specified the information about the problems existing in the current situation, it did not provide a clear guidance on implementing a new solution. This is a practical issue that prevent us from directly applying the CommonKADS analysis to the development of a new knowledge management system for EMS.
Even though the CommonKADS analysis can draw our attention to the knowledge management in the Dispatch Centre and specific problems associated with one of the dispatchers’ tasks—Emergency Assessment, have been identified, it did not indicate any direction for solving the problems. The CommondKADS framework lacks pre-defined general outcome for different kinds of input to each model in the framework. Thus, to make use of the CommonKADS analysis, we had better to put its results to other more practical frameworks and figure out the suggestion for a new solution.
3 Theoretical Frameworks
3.1 The SECI Model and Four Types of “Ba”
Nonaka and Konno (1998) introduced the Japanese concept of “Ba” to organisational theory. Ba is a shared space for emerging relationships such as a physical, virtual or mental space. They believe that knowledge is embedded in Ba, and knowledge is created within a spiralling process of interaction between explicit and tact knowledge, which is based on four specific platforms, namely Socialisation, Externalisation, Combination and Internalisation—the SECI Model. There are four types of Ba that correspond to the four stages of the SECI Model (Nonaka and Konno 1998):
(1) Originating Ba for Socialisation: Originating Ba is the place where individuals share feelings, emotions, experiences and mental models. It supports Socialisation in which tacit knowledge is exchanged through joint activities.
(2) Interacting Ba for Externalisation: Interacting Ba is the place where tacit knowledge is made explicit via peer-to-peer dialogue and extensive use of metaphors. This process represents Externalisation.
(3) Cyber Ba for Combination: Cyber Ba is the place of interaction in a virtual world instead of real space and time, where new explicit knowledge is generated and systematised through out the organisation by the combination of new explicit knowledge and existing information and knowledge.
(4) Exercising Ba for Internalisation: Exercising Ba is the place where the conversion of explicit knowledge to tacit knowledge is facilitated. Such conversion takes place when individuals use explicit knowledge in real life or simulated applications. Eventually the individuals internalise the knowledge.
3.2 Information Governance Models
Based on the degree of local or centralised control of the information environment, March (1997) developed four information governance models to describe the features of an organisation in terms of information politics:
(1) Information Monarchy: one individual or function controls most of an organisation’s information.
(2) Information Federalism: only a few information elements need to be defined and managed centrally, while the rest can be left up to local units.
(3) Information Feudalism: business unit managers control their information environments like lords in so many separate castles.
(4) Information Anarchy: every individual fends for himself or herself and defines information on their own terms.
These four models are based on the consideration of the control of information. There are some other models based on other dimensions. For example, a Market-Based Model can be used to describe organisations that put a variety of different types of information into a database but only maintain that which is heavily accessed by users. In other words, the demand for information controls how it is governed. Furthermore, a Technocratic Utopias Model can be used to describe those organisations assuming that technology will solve all problems of information governance (March 1997).
4.1 Using the SECI Model for a Systematic Solution
The SECI Model associated with the four types of Ba provides us with systematic view of knowledge creation and conversion and it is useful for analysing the EMS case from a systems perspective. Applying the SECI Model to the case can complement the CommonKADS method’s weakness in terms of systematic analysis.
To implement the new solution (i.e., developing a priority service system for AMI patients and allowing actual or suspicious AMI patients to call EMS directly), the dispatchers should play a critical role the emergency service processes. Once the dispatcher receives a call from a patient who claims he or she has AMI, the dispatcher should use assess the emergency based on what the patient says and determine if the case is eligible for the priority service. According to the case description and the CommonKADS analysis (He 2009), the main knowledge for assessing emergency was triage, but the knowledge was tacit and difficult to transfer. Sometimes the dispatchers have limitation in triage of some illness (e.g., AMI). Furthermore, the dispatchers did not socialise with the Ambulance personnel so their knowledge can not be exchanged and converted.
If we apply the SECI model in the implementation of the new solution, we should construct the four types of Ba to facilitate the four stages of knowledge conversion. The dispatchers should socialise with the Ambulance personnel so that they exchange tacit knowledge about patients who need emergent treatment (Socialisation). Then they should work with the AMI experts to develop an explicit protocol specifying what criteria should be met for determining a caller as suspicious AMI patients (Externalisation). After that, the protocol should be used for training and assessing dispatchers (Combination). Finally the dispatchers apply the new explicit knowledge into their work and make it tacit again (Internalisation). As a result, they may use the knowledge to assess emergency more accurately and efficiently.
4.2 The Information Federalism Model as a Guidance on Implementing the New Solution
The CommonKADS analysis lacks guidance on implementing the new solution because it does not generate output (e.g., suggestion) after we input information into its various models, whereas March’s (1997) information governance models not only helps us classify the information politics within an organisation but also provides us with suggestion on how to take advantage of a particular model.
Generally, the Information Federalism Model may be suitable for describing EMS’s information environment. On the one hand, EMS is part of a complex system—Municipal Medical and Sanitary Service and EMS define their own information such as the procedure of dealing with a call at the Dispatch Centre. On the other hand, EMS is controlled and supervised by General and Social Sanitary Care. EMS should follow various guidelines defined by their higher management. For example, they are asked to minimise the number of dispatches that do not result in patient transport to the hospital.
To apply the model into the implementation of the new solution, General and Social Sanitary Care should allocate AMI experts to work with the dispatchers to develop a protocol for assessing calls claiming AMI. Such protocol is information developed centrally and shared across departments. On the other hand, Dispatch Centre and Ambulance Service can still define their own ways for implementing the protocol. For example, Dispatch Centre can define their own plan for training the dispatchers to use the protocol in their work, and Ambulance Service can define what paramedics and drivers should do once they are told to pick up an AMI patient.
CommonKADS analysis can effectively help us locate and define problems within an organisation and its business processes. Nevertheless, it can not provide us with a systematic view for the solution, nor does it output clear guidance on implementing solutions. The SECI Model and the information governance models can complement CommonKADS. In this paper, the two frameworks have been used to perform a social analysis of the EMS case in regard to the implementation of the new solution. On the one hand, the SECI Model is used to facilitate knowledge creation and conversion within EMS. On the other, the Information Federalism model depicts a guideline for both higher management and local units to implement the new solution.
He, W. 2009. ‘Modelling Emergent Medical Service in the Netherlands with CommonCADS’: Unpublished assignment for ISIT917, University of Wollongong, Australia.
March, J 1997, ‘Information politics: Information is not innocent’, in Davenport, T H & Prusak, L (eds.), Information Ecology: Mastering the Information and Knowledge Environment, Oxford University Press, New York, pp67-82.
Nonaka, I & Konno, N 1998, ‘The concept of “Ba”: Building a foundation for knowledge creation’, California Management Review, vol.40, no.3, pp40-54.
Schreiber, G, Akkermans, H, Anjewierden, A, De Hoog, R, Shadbolt, N, Van de Velde, W & Wielinga, B 2000, Knowledge Engineering and Management : the CommonKADS Methodology, MIT Press, Cambridge.