The Knowledge-Value Chain: A Conceptual Framework for Knowledge Translation in HealthFrom knowledge to the knowledge-value chain -- By defining knowledge as the capacity to act, we postulate that the combined use of knowledge and other resources gives organizations their capabilities for action. There is no consensus with respect to the critical capabilities required to manage knowledge productively. In public health, five dyadic capabilities appear to be of critical importance: (1) the capabilities of mapping and acquisition complement each other; (2) creation is partly associated with destruction; (3) integration is dependent on sharing and transfer; (4) replication is related to protection; and (5) performance assessment is linked with innovation. Knowledge creation is the capability that has received the most attention from the research community. The other capabilities are less well documented but the management literature has something to say about all of them.From an organizational perspective, the interdependence of such dyadic capabilities generates a knowledge-value chain that moves from knowledge mapping and acquisition up to the production and delivery of new or improved public health programmes and interventions delivering added value for people. The mission, vision, goals and strategies of a public health organization or social enterprise drive the knowledge-value chain. The higher the knowledge performance related to dyadic capabilities, the higher the value generatedWorld Health OrganizationWHO_751c6980-ad8b-11e0-83d4-4a877a64ea2aRéjean LandryCo-Author -- Department of Management, Faculty of Business, Laval University, Québec City, Canada G1K 7P4Nabil AmaraCo-Author -- Department of Management, Faculty of Business, Laval University, Québec City, Canada G1K 7P4Ariel Pablos-MendesCo-Author -- Department of Knowledge Management and Sharing, World Health Organization, 1211 Geneva 27, Switzerland. Correspondence to Ramesh Shademani (email: shademanir@who.int)Ramesh ShademaniCo-Author -- Department of Knowledge Management and Sharing, World Health Organization, 1211 Geneva 27, Switzerland. Correspondence to Ramesh Shademani (email: shademanir@who.int)Irving GoldCo-Author -- Canadian Health Services Research Foundation, Ottawa, Ontario, CanadaFinancial SupportersRéjean Landry and Nabil Amara acknowledge the financial support of the Canadian Health Services Research Foundation and Canadian Institutes of Health Research for the preparation of this paperCanadian Health Services Research FoundationCanadian Institutes of Health ResearchHealth OrganizationsWhat does knowledge mean for public health organizations -- Knowledge constitutes an intangible resource that takes multivariate forms. Blumentritt & Johnston have reviewed the most frequently cited typologies of knowledge. Their review shows that there is an overlap between typologies. Clearly, there is no consensus about the level of analysis at which knowledge is a valid concept. For the sake of this paper it is useful to categorize knowledge according to its articulability and its holders. Articulability refers to the differentiation between explicit (or codified) knowledge and tacit knowledge. Explicit knowledge is knowledge that can be consciously understood and articulated, for example, in the form of scientific articles, books, guidelines and electronic records. It includes explanatory knowledge and explicit propositions. Tacit knowledge is knowledge that the knowledge holder is not aware of. For instance, the knowledge holder may know how to ride a bicycle but could articulate this know-how only with great effort._62f6a9fe-ee28-11ea-91a9-8e4b2383ea00To enable productive management of knowledge_62f6ab0c-ee28-11ea-91a9-8e4b2383ea00KnowledgeKnowledge translation problems:AccessKnowledge access -- At its root, KT is often pre-empted by basic access to key information and expertise. This applies both to the ability to learn of the existence of knowledge and the ability to retrieve it in a timely and usable form. The end results are wasted opportunities and reinventing of wheels. The sheer volume of information available is itself a challenge, as are the digital divide and the exclusionary nature of expensive intellectual property. Indexes, search engines, expertise locators and social networks are making it much easier today, as are various public and private efforts to facilitate affordable access to premier information and know-how.CompletenessKnowledge incompleteness -- When the attributes of the knowledge in a given transfer transaction are not completely specified, knowledge incompleteness happens. Research knowledge represents abstract principles dealing with fundamental relations between causes and effects. There might be a gap between these abstract principles and their concrete application in new or improved products and services. Proof that abstract principles work is frequently not provided to the recipients of knowledge transfer. The probability that recipients of knowledge transfer receive usable technical solutions decreases as research knowledge becomes more complex.SymmetryKnowledge asymmetry -- Knowledge asymmetry occurs when knowledge “users” know more about the problems that need solving and knowledge “producers” know more about the solutions. There exists a cognitive distance between the sources of a given knowledge transaction and its targets. Knowledge users may be sceptical about the multiple solutions offered, while knowledge producers might feel undervalued. The development of trust between users and producers can go a long way towards facilitating KT; this trust may pass through intermediaries or entrepreneurs who find a timely angle to turn a given asymmetry into a worthy challenge and gradient of opportunity.ValueKnowledge valuation -- This is a central issue in knowledge exchange and technology transfer. People exchange knowledge when the value gained by the parties is greater than the costs involved. In addition to the cases of information encoded in patents or embedded in technologies and devices traded on the private market, it is usually difficult to put an overall value on knowledge because it is often intangible, largely uncodified or spread over groups of people. Importantly, valuation brings up issues of trading intellectual and financial capital or some other utilitarian currency. Often, however, social capital is involved to facilitate knowledge transactions more efficiently.CompatibilityKnowledge incompatibility -- Knowledge incompatibility arises when knowledge producers or intermediaries attempt to transfer to organizations or communities knowledge that is not compatible with their mission, historical context, values, skills, resources and prior investments in technologies. The contributions of languages and dialects to knowledge incompatibility grow as the limits of geographical borders and distances fall in the era of information and communication technologyArticulabilityArticulability refers to the differentiation between explicit (or codified) knowledge and tacit knowledge. Mapping & AcquisitionLearn what organizations know._62f6abca-ee28-11ea-91a9-8e4b2383ea001Knowledge mapping and acquisitionInternal KnowledgeUnderstand internal knowledge resources and their limitations._62f6acce-ee28-11ea-91a9-8e4b2383ea001.1The internal knowledge mapping in a public health organization allows it to learn what it knows. It refers to the understanding and self-awareness that an organization has with respect to its knowledge resources and their limitations. Internal knowledge is especially important because it is unique, specific to the organization, tacit and therefore difficult to reproduce by knowledge holders located outside the organization.External SourcesIdentify and acquire knowledge from external sources._62f6ae36-ee28-11ea-91a9-8e4b2383ea001.2On the other hand, external knowledge acquisition refers to a capability for external awareness, more specifically to the capacity for identifying and acquiring knowledge from external sources and making it suitable for subsequent use by the organization. Knowledge mapping and acquisition involve many specific capacities — for example, locating, accessing, valuing and filtering pertinent knowledge; extracting, collecting, distilling, refining, interpreting, packaging and transforming the captured knowledge into usable knowledge; and transferring the usable knowledge within the organization for subsequent use in problem solving. External knowledge may provide new ideas and contexts for benchmarking internal knowledge; this type of knowledge is more explicit and more costly to acquire but it is easily available from other similar public health organizations.GapsIdentify gaps between what public health organizations need to know versus what they currently know._62f6aef4-ee28-11ea-91a9-8e4b2383ea001.3Based on the results of the knowledge mapping and acquisition diagnostic, one could attempt to look into the knowledge gap that may exist between what a public health organization has to know to implement its mandate and what it currently knows. This assessment may lead to one of three conclusions: (1) the organization faces a situation where there is an internal knowledge gap if it does not know enough to implement its public health mandate; (2) the organization has an external knowledge gap if it knows less than what other public health organizations know in order to implement similar mandates; (3) the organization has no knowledge gap if it knows enough to implement its mandate or if it knows more than other public health organizations know in order to implement similar mandates.OrganizationOrganize information._62f6afc6-ee28-11ea-91a9-8e4b2383ea001.4Knowledge mapping and acquisition may rely on one of four organizational modes: undirected viewing, conditioned viewing, informal search and formal search. In undirected viewing, a public health professional is exposed to information when he or she has no specific public health informational needs in mind. Undirected viewing is an informal strategy that can be useful for the early detection of emerging problems. In conditioned viewing, a public health professional directs his or her viewing on information regarding selected public health topics or issues. During the informal search process, a public health professional looks for information that will improve his or her understanding of a specific public health issue. Finally, in a formal search a public health professional engages in a systematic search for ideas, information and knowledge about a specific public health issue. This last mode includes conducting systematic reviews and external surveys as well as training and hiring employees (in order to bring knowledge into the organization). The other mapping and acquisition modes are more likely to rely on identifying and acquiring ideas, information and knowledge through informal networks.Creation & DestructionCreate and destroy knowledge._62f6b08e-ee28-11ea-91a9-8e4b2383ea002Knowledge creation and destruction -- The size of internal and external knowledge gaps influences knowledge-creation efforts.CombinationCombine knowledge to develop new knowledge._62f6b156-ee28-11ea-91a9-8e4b2383ea002.1IndividualsOnly individuals can create knowledge.OrganizationsOrganizations support and amplify the knowledge created by individuals.The knowledge-creation capability refers to the capacity to combine knowledge (tacit, explicit, individual and collective, internal and external) in order to develop new knowledge. Knowledge creation is usually associated with research and development activities. However, it should also be understood to include activities such as solving a public health problem, devising a public health promotion strategy, discovering a pattern, developing a public health programme or intervention, or conducting monitoring and evaluation activities.DestructionDestroy old knowledge._62f6b246-ee28-11ea-91a9-8e4b2383ea002.2We know little about the knowledge-destruction capability, which is the capacity to eliminate pieces of knowledge or disentangle the interconnectedness of pieces of knowledge. Two examples of knowledge that are frequently targeted for destruction include professional behaviour based on experience and organizational routines.ImplementationImplement new knowledge._62f6b322-ee28-11ea-91a9-8e4b2383ea002.3Knowledge destruction frequently paves the way for knowledge creation and innovation. However, the adoption of budgets for or spending on restructuring and re-engineering shows how difficult it is to abandon old knowledge. The literature on evidence-based medicine also shows to what extent it is difficult to destroy old knowledge and replace it with the implementation of new knowledge (for example, replacing old clinical guidelines with new).IntegrationIntegrate and share knowledge._62f6b3f4-ee28-11ea-91a9-8e4b2383ea003Knowledge integration and sharing/transfer -- Knowledge integration is the capacity to transform a public health organization’s knowledge resources (tacit, explicit, individual, organizational, internal, external) into actionable knowledge by taking into account the organization’s strengths, weaknesses and opportunities as well as threats to the organization.SynthesisSynthesize internal knowledge and to integrate it with acquired knowledge._62f6b4e4-ee28-11ea-91a9-8e4b2383ea003.1Over time, public health organizations develop more or less explicit processes to synthesize the internal knowledge accumulated and to integrate it with knowledge acquired from other organizations or other external sources (such as scientific publications or clinical guidelines). Organizations integrate the knowledge accumulated over time, developing and delivering programmes, interventions and services using knowledge from external sources. SharingShare knowledge._62f6b5c0-ee28-11ea-91a9-8e4b2383ea003.2Integrating disjointed pieces of raw knowledge into actionable knowledge is necessary but not sufficient to solve public health problems; knowledge must also be shared and transferred. Knowledge sharing refers to the capacity to make available pertinent knowledge to others within an organization, a programme, a project or an intervention. Knowledge sharing is more demanding than knowledge reporting. Reporting involves disseminating information through codified formats (such as an IT system) to target groups within a public health organization. By contrast, sharing implies person-to-person interactions during which one individual converts his or her (individual and often tacit) knowledge into a form that can be understood by other members in the organization. Knowledge sharing provides the mechanism to transform individual knowledge into organizational knowledge that can be redeployed to create value and solve problems at the organizational level. Knowledge sharing is a social process that may lead to the emergence of communities of practice. In public health, such communities exist at the local, regional, national and international levels.TransferTransfer knowledge._62f6b69c-ee28-11ea-91a9-8e4b2383ea003.3Knowledge transfer complements knowledge sharing. Like Ipe, we associate sharing with an exchange of knowledge between individuals and we associate transfer with the exchange of knowledge between organizations or departments or divisions within organizations. The literature has identified many factors that contribute to the successful sharing and transfer of knowledge: the type of knowledge, the formal and informal mechanisms linking the sources and recipients of knowledge that provide opportunities to share and exchange, and organizational factors, which include the culture of the work environment.Replication & ProtectionReplicate and protect knowledge._62f6b796-ee28-11ea-91a9-8e4b2383ea004Knowledge replication and protection -- The knowledge that has been shared or transferred provides a template or a guideline for decisions and actions. Knowledge replication is the capacity to identify the attributes of the knowledge that are replicable, how these attributes can be recreated, and the characteristics of the contexts in which they can be replicated successfully. Replicating templates and guidelines is never easy. There are always significant differences between the attributes of the knowledge and the context of the action and decisions described in the templates and guidelines, and a real public health context. Moreover, the knowledge that is shared and transferred is never provided with “how-to” manuals appropriate to fit all local conditions. The many idiosyncratic features of the local context in which public health organizations operate make the precise replication of templates and guidelines difficult, if not impossible. Knowledge replication must be guided by the attributes of the local context of actions and decisions, especially with respect to public health. The capacity to replicate knowledge improves the efficacy and efficiency of public health programmes and interventions. However, knowledge replication is limited by many legal mechanisms of knowledge protection, such as patents, copyrights, trademarks and confidentiality agreements.AttributesIdentify the attributes of the knowledge that are replicable._62f6b886-ee28-11ea-91a9-8e4b2383ea004.1MeansDetermine how those attributes can be recreated._62f6b976-ee28-11ea-91a9-8e4b2383ea004.2ContextsIdentify the characteristics of the contexts in which they can be replicated successfully._62f6ba7a-ee28-11ea-91a9-8e4b2383ea004.3ProtectionAppropriately protect knowledge._62f6bb6a-ee28-11ea-91a9-8e4b2383ea004.4Public health organizations aim to facilitate knowledge replication in a context in which the biomedical industry frequently places the emphasis on knowledge protection (patent protection).Performance & InnovationAssess of knowledge performance and innovation._62f6bc64-ee28-11ea-91a9-8e4b2383ea005Knowledge performance and innovation -- The assessment of knowledge performance is the capacity to assess to what extent the replication of knowledge delivers the desired outputs and outcomes. Assessments are usually undertaken for one or a combination of perspectives that aim to balance the financial and non-financial outputs and outcomes. These perspectives assess:BenefitsAssess the public health benefits._62f6bd68-ee28-11ea-91a9-8e4b2383ea005.11. value for money — the public health benefits arising from investments in the creation, sharing and application of knowledge;UsageAssess the extent to which decisions, enterprises and practices are based on sound evidence._62f6be62-ee28-11ea-91a9-8e4b2383ea005.2knowledge users — the extent to which public health policy decisions, community enterprises and professional practices are based on sound evidence and the extent to which evidence-based policy decisions and evidence-based professional practices contribute to the development of new products and services or improve them;OutcomesAssess the extent to which evidence-based policy decisions and evidence-based professional practices are translated into public health outcomes._62f6bf66-ee28-11ea-91a9-8e4b2383ea005.3final beneficiaries of knowledge translation — the extent to which evidence-based policy decisions and evidence-based professional practices are translated into new or improved products and services and superior public health outcomes;ProcessesAssess internal organizational processes._62f6c074-ee28-11ea-91a9-8e4b2383ea005.4internal organizational process — to provide an account of the activities and processes that public health organizations must develop and excel at to achieve a milieu of superior knowledge creation, sharing, transfer and replication for evidence-based policy decisions and evidence-based professional practices and to achieve superior outcomes for the final beneficiaries of knowledge application. The performance-assessment capability is oriented towards the short term. It should always be complemented by an innovation capability that is more future-oriented. The innovation capability is the capacity to develop a better understanding of the knowledge application process to enhance the future use of research evidence and other sources of knowledge in the development and improvement of products and services and to achieve superior outcomes for the final beneficiaries of knowledge translation.2006-06-022020-09-03https://www.researchgate.net/publication/6869769_The_knowledge-value_chain_A_conceptual_framework_for_knowledge_translation_in_healthOwenAmburOwen.Ambur@verizon.net