Abstract
There is a growing literature on health and health care dedicated to empowerment of patients; but there is still a gap in the literature to conceptualize knowledge, to extend the discussion of the empowerment of the patients to the stakeholders. The discussion is at the level of managerial processes of empowerment and knowledge management related to health care. The present chapter starts with a review on empowerment, especially focused on the health sector. The following sections will develop a critical analysis of empowerment, mainly around the concept of tacit knowledge (Polanyi) and knowledge management. One key variable is the proximity of the actors involved in the empowerment process. This key variable is very much related to the tacitness issue of knowledge production and flows. The chapter extends the discussion of the empowerment of the patients to that of the stakeholders and the general debate about health literacy. A model is briefly described for the purpose of illustrating the learning process in a knowledge management implemented in health care.
TopIntroduction
The recent transformations in the economy and society are often referred to as the knowledge economy, the information society or even the knowledge society (Amin & Cohendet, 2004; Amin & Roberts, 2008; Antonelli, Foray, Hall, & Steinmueller, 2006; Carayannis, Pirzadeh, & Popescu, 2011; De la Mothe & Foray, 2001; Foray, 2010; Kahin & Foray, 2006; Lam, 2000). These transformations impact most sectors; and health care is no exception. It is a major provider of knowledge-intensive services that are going through a rather swift adoption of new information systems and knowledge management processes that parallel the concomitant emergence of new management models (J. Birkinshaw, 2010; Julian Birkinshaw, Hamel, & Mol, 2008; Julian Birkinshaw, Nobel, & Ridderstråle, 2002; Raisch & Birkinshaw, 2008). Related to these issues –in public policies, social action and management– the notion of empowerment has spread widely. Now, as discussed here, it is affecting health care models, institutions, businesses and management as much as the structuration and the organization of the whole sector.
Key Terms in this Chapter
Health: Health, according to the World Health Organization, is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The modern definition of health is an ability, or, to use, Amartya Sen perspective, a capability.
Electronic Health Record: (EHR and also Electronic Health Registry): See also electronic patient registry, medical electronic record. This is the creation of digital information, its storing, management, transmission, access, modification and use across a health care unit, several units or even a whole system of health care. In its basic generic form, the definition of EHR, according to the document ISO/TR 20514:2005 of the ISO – International Standards Organization, can be stated as followed: “repository of information regarding the health status of a subject of care, in computer processable form” (ISO, 2005 AU446: Anchored Object 222 ).
Knowledge Management: Without entering any controversy, following Jashapara (2011: 16) AU451: The in-text citation "Jashapara (2011: 16)" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. , we define knowledge management as “the effective learning processes associated with exploration, exploitation and sharing of human knowledge (tacit and explicit) that use appropriate technology and cultural environments to enhance an organization’s intellectual capital and performance.” It must be extended in health empowerment to groups and social interaction.
Empowerment: Empowerment in its modern sense (from the late 1950s to today) must be distinguished from its ancient forms, in which the concept was not considered as a general and adequate character for a wide and not much constrained use like today. Authoritarian regimes and old civilizations retained much its scope. (This theme is central to Polanyi´s philosophical endeavor that we do not discuss here; for a hint, see Jah (2002: 1-47) AU447: The in-text citation "Jah (2002: 1-47)" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. . According to the Cornell empowerment Group: “Empowerment is an intentional, ongoing process centered in the local community, involving mutual respect, critical reflection, caring, and group participation, through which people lacking an equal share of valued resources gain greater access to and control over those resources” (Zimmerman 2000: 43). It is important to stress that empowerment is generally construed at the organizational and the community levels (Zimmerman 2000: 44).
Routines: Routines are repeated and stabilized in time patterns of behaviors in organizations and groups. Processes in organizations, when stabilized, can also be considered as routines.
Tacit Knowledge: As Michael Polanyi (1967: 4) AU452: The in-text citation "Michael Polanyi (1967: 4)" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. wrote in The Tacit Dimension, we should start from the fact that ‘we can know more than we can tell‘. Jashapara (2011) AU453: The in-text citation "Jashapara (2011)" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. identifies tacit knowledge to knowing how or intelligence, in a tentative to approximate the concepts of knowledge developed by Michael Polanyi and Gilbert Ryle. It is frequent in the literature to find an opposition between tacit and codified knowledge, construing tacitness as a residual category. This is not our stance, given the complexity of the notion of knowledge and its dynamics, both in science and technological, technical and professional settings.
Interactive Health Literacy: (See also functional health literacy and critical health literacy, in this glossary) Interactive health literacy is the second level of empowerment and promotes self help, seizing of opportunities to develop individual skills. The focus here is the individual, its attitude and behavior. It is also more time oriented, meaning to help change individual perceptions, attitudes and knowledge.
Critical Health Literacy: (See also interactive health literacy and functional health literacy, in this glossary) Critical health literacy is characterized by a focus on groups and context, with the provision of information on social, economic and group determinants of health and how to lead to change, both at the individual, group and community levels (Mårtensson & Hensing, 2012 AU441: Anchored Object 217 ; Nutbeam, 2000 AU442: Anchored Object 218 ; WHO, 1998 AU443: Anchored Object 219 ). It is the third level of health literacy and the most comprehensive one, going beyond the individual as a learner and getting into matters of management, collective choice, decision and public policies.
EHEALTH, eHealth, or E-Health: A concept comprising all applications used at the level of information technology, including the Internet, to enable more efficient patient care, thereby improving access and the quality of management of clinical processes. The Electronic Health Record (EHR) is part of this set of tools. E-health can be considered as a current avenue for implementing policies that aim at empowering patients and actors in the health care sector (Jacquinet & Curado, 2016 AU444: Anchored Object 220 ; Porfírio, Jacquinet, & Carrilho, 2013 AU445: Anchored Object 221 ).
Functional Health Literacy: (See also interactive health literacy and critical health literacy, in this glossary) Functional health literacy is the first level of empowerment, its most basic component with a focus on factual information related to health. It is typically represented by flyers, charts, and information given to the patient on a variety of subjects related to health care, from access to precautionary behavior (Nutbeam, 2000). It is not limited to information sharing, however, yet, this is its main component. This is related to the more basic concept of literacy focusing on knowledge and information transmission but not much focus on action and management.
Health Promotion: Health promotion can be defined as the process of “enabling people to increase control over and improve their health (WHO, 1998 AU450: Anchored Object 223 ). Health is seen as a resource for everyday life, not the objective of living. Health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well being.” ( http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ , accessed on September 30 2016)
Health Literacy: Health literacy is defined by the World Health Organization (WHO) as the “cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health (Martenson and Hensing 2012 AU448: The in-text citation "Martenson and Hensing 2012" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. : 151; see also WHO 1998) There are, according to Nutebeam (2000) AU449: The in-text citation "Nutebeam (2000)" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. , three levels of health literacy: the basic one, functional health literacy, that is centered on factual information; the intermediate level or interactive health literacy that is centered on the development of individual skills and its direct context; and, finally, the critical health literacy that relate the individual to the community and public policies as well as the behavioral change of a population in its global context, not just the direct or obvious one.
Complexity: Complexity has two different meanings that are of interest for research and must be distinguished: one is complexity as reality or object of study, and the other complexity as method or way of approaching issues. In the first conception, reality is complex because it is composed of distinct and interwoven and intermingled elements that create a whole superior to its parts and structured through different levels of reality. In the second sense, complexity as method, it is a way of understanding and study reality in its multiple dimensions and reciprocal interdependencies. In this second acceptance, complexity is also synonymous of interdisciplinarity or transdisciplinarity. It is also sometimes referred to the science or sciences of complexity.
Health Information: This concept means all kinds of information (past, present or future) directly or indirectly linked to a person’s health, or clinical and family history, whether that person is alive or deceased. It is not limited to the knowledge produced and exchange by health professionals. It includes the patient information, among other types of information.