Knowledge Sharing among NHS Estates and Facilities Management Teams: Insights across Managerial Levels and Organisational Contexts

Abstract

Estates and Facilities Management (EFM) departments in the UK’s National Health Service (NHS) play a crucial role in ensuring the safe delivery of healthcare services. Yet, they face numerous challenges, such as diminishing budgets, staffing issues, ambitious net zero carbon targets, and growing maintenance backlogs. Despite the recognised benefits of knowledge sharing (KS) – such as improved workforce satisfaction, increased efficiency, and cost reduction – KS among NHS Trusts remains limited, as evidenced by academic literature and multiple calls to action from NHS bodies. While some studies have addressed this gap by analysing the underlying mechanisms and influencing factors of KS in healthcare settings, the focus was mostly on the flow of evidence-based clinical knowledge. However, little research has been conducted on inter-organisational KS processes among non-clinical hospital departments, such as EFM. Moreover, existing research has overlooked the variation in KS needs and behaviours across managerial levels. To address the research gaps outlined above, this thesis uses the cultural historical activity theory (CHAT) framework to explore (i) the different areas of knowledge relevant to the EFM domain, (ii) the organisational and boundary factors impacting KS, and (iii) KS channels, particularly differentiating across managerial levels. Following a pragmatist and Engaged Scholarship approach, the study uses the Design Research Methodology (DRM) to build upon existing theories while fostering new actionable insights. Due to the complexity of human behaviour involved in KS processes, a mixed-methods approach was employed. Qualitative data were collected from 19 exploratory interviews and a multiple-case study with 35 semi-structured interviews across seven NHS Trusts. These Case studies specifically examined the challenges associated with medical gas pipeline systems (MGPS) during the COVID-19 pandemic, offering a unique opportunity to study KS under extraordinary conditions, where an overriding common goal helped remove many of the existing organisational and social barriers. Additionally, quantitative data were collected through a multi-panel Delphi study involving 165 EFM professionals across three rounds of online questionnaires. The study identifies (i) 14 distinct knowledge areas with varying priorities across different managerial levels, (ii) the effectiveness and areas for improvements for channels used to share documented and undocumented knowledge, and (iii) crucial contextual factors, including geographical, infrastructural, organisational, leadership, and cultural factors that influence effective KS. This study contributes to the theoretical understanding of KS in non-clinical healthcare settings by extending the CHAT framework to EFM, uncovering role-specific disparities in KS behaviours across managerial levels, and adapting the Delphi technique to capture diverse perspectives. Additionally, it provides insights into challenges during the COVID-19 pandemic and highlights the multifaceted organisational, contextual, and boundary factors influencing KS in EFM, offering a comprehensive foundation for future research. The study also offers practical recommendations for NHS England, NHS Trusts, and professional bodies to enhance KS practices by addressing organisational and cultural barriers, focusing on role-specific skills gaps, and embedding collaborative responsibilities into organisational processes. Through ten distinct personas and four practical recommendations, the study equips stakeholders with actionable tools to enhance the efficiency of KS within the NHS and other healthcare systems.