【作者】 曹征；

【导师】 孙虹；

【作者基本信息】 中南大学 ， 公共管理， 2012， 博士

【摘要】 隐性知识,是组织、团队与个人等通过特定方式获取的,无法用言语来清楚表达、难以被复制和传播的、具有内隐性的知识。医务人员隐性知识,是医务人员通过长期临床实践、后天学习以及个人生活体验积累而来的,是无形的,是存在于人大脑的工作程序、某种情景里的非编码化之知识。由于不易表达、记载而难以得到并传播。是临床工作中应用的技能、经验、技巧以及在治疗、护理等过程中的感悟、思维方式、观察能力、分析能力、决策能力及其价值体系的总和。医务人员隐性知识最终影响医务人员对疾病的判断和处理,影响他们对临床事务做出抉择的能力和工作执行力。通过对医务人员隐性知识的有效管理,发挥其最大效益,使医务人员面对临床事务的应变能力和创新能力不断提升,构筑强有力的医务人员隐性知识管理体系,从而塑造并不断提高医院高价值、不可模仿与替代的核心竞争能力。本研究采用文献研究、专家访谈、实证研究等多种方法,在知识管理理论、信息传递理论、学习组织理论的基础上,对医务人员隐性知识传递网络及影响因素进行了定性及定量研究。对医院及医务人员隐性知识内容、特点、作用、结构、传递模式及路径进行了研究。把社会网络理论的关系要素和结构要素引入医务人员隐性知识管理中,延伸研究了医务人员隐性知识传递网络形成背景与动机、特点与作用、共享性和多层次性及网络管理,为医务人员隐性知识传递网络研究提供了新的思路。研究了医务人员隐性知识传递有效性及影响因素,并把组织文化因素作为解决组织的外部适应性和内部一致性方面的重要问题,为医务人员隐性知识传递网络研究提供了新的视野。通过前面的定性研究,结合国内医院实际状况,建立了医务人员隐性知识传递网络及影响因素研究模型,采用采用软件SPSS18.0版,对医务人员隐性知识传递及显性化两个过程使用上述同一模型进行统计定量分析。从医学知识特性、发送方、接收方、传递情景等方面选取了医学知识缄默复杂性、发送意愿、抵触接收、管理者忽视、知识差距五个影响因素,选取了外部沟通、组织沟通、人际沟通三个传递网络,提出了研究假设。设计了访谈提纲及调查问卷。5个影响因素共采用15个问卷题项、3个传递网络共采用9个问卷题项、传递效果采用7个问卷题项进行变量定义和测度。经过文献阅读、专家讨论、题项产生、问卷试调查、问卷修改与重新设计,然后进行大规模问卷发放。调查问卷各题项一律采用Likert-type五点量表。进行了量表品质检验。采用Cronbach’s alpha系数检验量表信度。效度分析采用KMO样本测度(Kaiser-Meyer-Olkin Measure of Sampling Adequacy)和巴特利特球体(Bartletttest of sphericity)检验,因子分析使用主成分法,旋转方法采用最大方差法。以湖南省株洲市、郴州市部分医院,采取随机抽样对210名医务人员作为研究对象,进行数据收集整理,在处理好多重共线性、序列相关、异方差问题后,采用多元线性回归方法,开展实证研究。研究结果指出,医学知识缄默复杂性在医务人员隐性知识传递及显性化过程中,对传递网络及传递效果均产生消极影响。传递意愿在医务人员隐性知识传递及显性化过程中,对传递网络及传递效果大部分均产生积极影响。抵触接收在医务人员隐性知识传递及显性化过程中,对传递网络及传递效果均产生消极影响。管理者忽视在医务人员隐性知识传递及显性化过程中,对传递网络及传递效果大部分均产生消极影响,但其在传递过程中,对人际沟通方式影响不明显。知识差距在医务人员隐性知识传递过程中,对外部沟通产生积极影响,对组织沟通影响不明显,对人际沟通产生消极影响；在显性化过程中,对外部沟通影响不明显,对组织沟通产生消极影响,对人际沟通产生消极影响；在两阶段中,均对传递效果产生消极影响。传递网络在受影响因素的影响程度上：外部沟通受抵触接收负向影响最大,组织沟通受管理者忽视负向影响最大,人际沟通受传递意愿正向影响最大。外部沟通在医务人员隐性知识传递及显性化过程中,对传递效果影响不明显。组织沟通、人际沟通在医务人员隐性知识传递及显性化过程中,对传递效果均产生积极影响。更多还原

【Abstract】 Tacit knowledge is obtained through specific manner by organization, group and individual, and is knowledge impossible to express clearly, difficult to duplicate and with internal tacit characteristic. The Medical personnel’s tacit knowledge is attained through individual’s long-term clinical practice, learning and experience gained from personal life, is the skills, experience and thinking, observation, analysis, decision-making skills and their value systems combined in the treatment and caring process of perception applied in clinical work, which is invisible numeralized knowledge existing in the work procedure and certain sense.The medical personnel’s tacit knowledge ultimately impacts the medical staff to judge treatment of disease, affect their ability to make choices and work execution of clinical affairs. How to effectively manage the hospital medical staff’s tacit knowledge, to build a strong hospital tacit knowledge management system, so the use of tacit knowledge would been greatly improved, so as to improve the hospital’s core competencies, is the ultimate goal for each medical institutions’object.This paper seeks to research qualitatively and quantitatively the transfer network and impact factors of medical personnel’s tacit knowledge, based on the methods of literature survey, expert visit, positive research, and theory of knowledge management, information transfer, organize study, describes the formation of tacit knowledge, content, delivery rules, effect and trace. The research, introducing the relationship and structure factors of social network theory to the the medical personnel’s tacit knowledge management, extended includes the formation background, characteristics, effects, sharing, multi hierarchy and network management, to provide relevant references for tacit knowledge delivery network research. It also studies the delivery effectivity and effect factors of tacit knowledge delivery network research, and treat the organization culture as the key point for solving the external adaptability and internal consistency, supplying the new field of vision on the medical personnel’s tacit knowledge studying. The medical personnel’s tacit knowledge delivery network and effect factors study model is established based on the previous qualitative study and combined with the practical conditions of domestic hospital by SPSS18.0. It is applied for the statistical quantitative research for the both procedures of tacit knowledge transfer and dominance. We adopt the five effect factors of medical knowledge’ silence complexity, transmitting desire, contradiction of receiving, ignoring of manager, distance on knowledge, three delivery networks of external communication, organization communication and interpersonal communication to propose the research assumption based on medical knowledge features, transmit leg, receive leg and delivery sense. We design the interview syllabus and questionnaire. The5effect factors utilize the15options, and the3delivery networks utilize the9options. The questionnaires are put out in large-scale before the documentary reading, expert discussion, options generation, questionnaire pre survey, questionnaire modification and redesign. The Cronbach’s alpha parameters check inter-scores reliability to guarantee the qualities. The efficiency analysis uses the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett test of sphericity. The factor analysis uses the main component method, and revolution error uses the maximum variance method. The practical study is operated by plurality linear regression after dealing with multiple colinearity, serial correlation and heteroscedasticity,for the subject investigated of210medical staff in Zhuzhou, Chenzhou city, Hunan province.The result indicated that the silent complexity had an negative effect on both transmission network and results in the process of medical staff’s tacit knowledge transfer and domination.However, delivery trend is on the contrary. The conflicting receiving had an negative effect on both transmission network and results in the process of medical staff’s tacit knowledge transfer and domination.The managers’ neglect mostly had an negative effect on both transmission network and results in the process of medical staff’s tacit knowledge transfer and domination. While it effects the interpersonal communication way unobviously in the process of transfer.In the process of tacit knowledge transfer, knowledge gap has a positive effect on the external communication way, the negative effect on the interpersonal communication way and no effect on the organization communication. In the process of domination, it has no effect on the external communication way, the negative effect on both the interpersonal communication way and the organization communication. In the two stages, it had negative effect on transmission result. The effected level of the delivery network can be concluded:the external communication is effected maximally by the interfered receive negative direction, and the organization communication is effected maximally by the organizer ignored negative direction, and the interpersonal communication is effected maximally by the delivery desire positive direction.The external communication had no effect on transmission results in the process of medical staff’s tacit knowledge transfer and domination. The interpersonal and organization communication ways both had a positive effect on transmission results in the process of medical staff’s tacit knowledge transfer and domination.更多还原