Towards sustainable and resilient healthcare: Exploring knowledge sharing barriers and channels among NHS hospital estates and facilities departments

Abstract

Hospital providers are facing unprecedented challenges such as ambitious sustainability targets while remaining resilient to adverse events, e.g. COVID-19. However, instead of leveraging the collective knowledge of all UK National Health Service (NHS) hospital providers, Hospital Estates and Facilities Management (HEFM) departments have to resort to using their own resources to find guidance and innovative solutions to their safety-critical infrastructure issues. This exploratory study draws upon academic studies from four domains: the institutional complexity of public healthcare systems, facilities management (FM), the ability to effectively manage change and inter-organisational knowledge sharing (KS). Various studies have stressed the lack of effective KS among NHS HEFM departments. However, so far, research studies exploring KS barriers and channels have either focused on KS among clinical disciplines or on FM organisations unaffected by the complexity of healthcare systems. Therefore, this paper develops a theoretical framework illustrating the underlying concepts and addresses the following question: What KS barriers and channels exist among NHS HEFM departments? Due to the complexity of the UK healthcare system, a complete understanding of the environment is needed before being able to understand the system itself. A systems approach is adopted, utilising mixed methods to study the dysfunctions of the existing system by understanding the interactions on multiple levels and identifying barriers to KS. The research incorporates a thorough review and analysis of the literature and 12 exploratory qualitative interviews with healthcare stakeholders and academic experts. The findings uncover a multitude of barriers throughout the KS process. Continuous structural reorganisations of the NHS, silo-thinking, inter-hospital competition, a lack of investment in professional development and additional complexities due to different ownership and service outsourcing models create a challenging environment for effective inter-organisational KS. Regarding KS channels, the NHS is still lacking a holistic strategy through which different types of documented and undocumented knowledge can be shared.