37° Congresso nazionale ANMDO
Bologna, 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
Wisdom
Implicitly knowing How to Generate Access and
Integrate Knowledge
Knowledge
Validated Platform for Action
Information
Patterned Data
Data
Dispersed Elements
THE 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)
Monitor
Knowledge
Use
Attività
Select, Tailor,
Implement
Interventions
KNOWLEDGE CREATION
1.Adempimenti DGRC n.596 del 5 agosto
Assess Barriers/
Supports to
Knowledge Use
Evaluate
Outcomes
2010
Knowledg
e Inquiry
2.Piano di riassetto della rete ospedaliera
Synthesis
Adapt
Knowledge
3.Piano
attuativo
to Local Context
Product
s/Tools
Sustain
Knowledge
Use
Identify Problem
4.Riqualificazione
Identify, Review,
Select Knowledge
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)
operate most of the time as automatic
pilot: spending least amount of
reflective thinking time on tasks they
spend most of their time doing
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
Knowledge gaps
Have
Esplicit Knowledge
Know
Knowledge you know
you have
Tacit Knowledge
Don’t know Knowledge you don’t
know you have
Don’t have
Knowledge gaps
Knowledge you know
you don’t have
Unknown gaps
Knowledge you don’t
know you don’t have
Knowledge-to-action (KTA)
Knowledge transfer and exchange: bringing together
researchers and stakeholders and facilitating their
interaction
Research utilization: moving research findings into
action.
Implementation Research: the scientific
study of methods to promote the systematic uptake
of clinical research findings and other evidence-based
practices into routine practice and, hence, to improve
the quality and effectiveness of health care.
Dissemination: the complex process of moving
research into practice
Graham et al. (2006)” Lost in Knowledge Translation: Time for a Map?”
The Journal of Continuing Education in the Health Professions
Knowledge as capabilities
Underlines the potential of organizational
structures and resources to support people
in their attempts to use knowledge
Knowledge as process
Emphasizes flexibility in knowledge use and
the need to contextualize knowledge
(plausibility, acceptability and feasibility)
Knowledge as codification
Focuses 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 blocks
reflect a constant tension between the
search for conformity between researchbased evidence and organizational practices
and the need for in-situ learning and
adaptation in order to bring about quality
and performance improvement
Denis, J-L, Lehoux, P (2009), Organizational theory,
Knowledge Translation in Health Care
Explicit (formal) knowledge
versus
Tacit knowledge
Knowledge gaps
Have
Esplicit Knowledge
Know
Knowledge you know
you have
Tacit Knowledge
Don’t know Knowledge you don’t
know you have
Don’t have
Knowledge gaps
Knowledge you know
you don’t have
Unknown gaps
Knowledge you don’t
know you don’t have
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 order to transmit it.
Examples of tacit knowledge include
subjective insights and intuitions.
Tacit knowledge (implications)
 With tacit knowledge, people are not
often aware of the knowledge they
possess or how it can be valuable to
others.
 Effective transfer of tacit knowledge
generally requires extensive personal
contact and trust.
In any organization the goal is to
create a hybrid design for its
knowledge management practice that
synthesizes the “right” combination
and balance of the tacit and explicit
knowledge management approaches.
The 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
increased dynamics of knowledge.
The supervisor cannot reasonably be expected
to be up to date and be able to understand
everything, when the knowledge that they use
changes.
As the half-life of knowledge decreases this
gap will increase ever further.
To remedy this effect, it will be important
that the supervisors become generalists when
they climb up the ranks.
European Commission, “Changing professions in 2015 and beyond”, 2006
Currently, a surgeon who has climbed up the ranks
supervises a set of surgeons.
He can therefore easily switch between the
surgeons he supervises.
In the future this will no longer be the case.
The doctors he supervises become more
specialised. Their expertise focuses on one area.
Consequently not only does the knowledge gap
between the various doctors increase, also the
gap of knowledge will increase between the
supervisor and his employees.
A change of skills of the doctors is therefore
essential.
European Commission, “Changing professions in 2015 and beyond”, 2006
The increased knowledge gap between
the various experts and their supervisors
will necessitate a change of skills.
In the future the supervisor will have to
be able to bridge the knowledge gap
between the doctors and him.
Unless the skills of the supervisor
change, these gaps cannot be
bridged.
European Commission, “Changing professions in 2015 and beyond”, 2006
As knowledge becomes more dynamic and
the amount of information is rising,
professionals in the health care sector will
face a choice. They can either generalise
or specialise.
European Commission, “Changing professions in 2015 and beyond”, 2006
Knowledge gaps
Have
Esplicit Knowledge
Know
Knowledge you know
you have
Tacit Knowledge
Don’t know Knowledge you don’t
know you have
Don’t have
Knowledge gaps
Knowledge you know
you don’t have
Unknown gaps
Knowledge you don’t
know you don’t have
Dalla 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 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 ristrutturare
rapidamente ed efficacemente i propri modelli
mentali, e che sono aperti alla sperimentazione
e accettazione di modelli mentali alternativi in
risposta agli stimoli che provengono
dall'esterno, sono quelli che riescono meglio ad
adattarsi all'ambiente, dato che sono in grado
affrontare situazioni nuove, impreviste e
complesse con decisioni maggiormente efficaci
ed efficienti (teoria della flessibilità cognitiva)
R. Trinchero in “Le risorse culturali della rete”, Milano, Franco Angeli, 2003
Nella competenza non rientra quindi solo la
padronanza di un modello mentale adeguato
ma anche la sua capacità di ristrutturazione
in relazione agli eventi contingenti. Questo
è uno degli elementi che contraddistingue il
comportamento comunemente definito
intelligente: il fatto di non rimanere fermi
ad oltranza sulle proprie posizioni ma di
sintonizzarsi di volta in volta sulla 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 / Sapere
Quando il Sapere tende a zero, il Denaro tende a infinito,
indipendentemente dal lavoro svolto.
Conclusion: The Less you Know, the More you Make.