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Knowledge Capital and Information Hospital Trustees Needis a research study conducted by James William Wyckoff for a fulfillment of a doctor of health administration (DHA) degree granted by School of Advanced Studies, University of Phoenix.
Introduction. This was a study to determine the information trustees need to be better strategic decision makers, and to identify and develop knowledge capital assets for competitive advantage.  Further, the study identified 5 trustee archetypes based on their information-seeking and using behavior, and recommended ways in which board chairs could enhance the information-gathering and supply of information to hospital trustees.
Background/ Need for ResearchKnowledge capital (KC), an aggregation of intangible assets and resources such as human capital (including intellectual capital), structural capital (processes and systems in an organization), and relational capital (relationships with clients, and strategic partners), is widely known to be a major portion of a corporation’s value.  However, ways of measuring KC are not generally agreed upon.  Furthermore, despite several studies among CEOs of America’s largest corporations overwhelmingly  indicating their desire to measure, manage, and monitor KC (95 percent said their companies should), only about five percent of these same corporations actually do!  Research among non-profits regarding information supplied to the board prior to regular meetings is nearly nonexistent. Some research into New York hospitals (Kovner, 2001) explored the amount of information supplied, and a few studies explored KC-related key performance indicators (KPIs) used in Texas and European hospitals (Love, Revere, and Black, 2008; Zigan, MacFarlane, and Desombre, 2007).The Wyckoff study sought to fill research gaps, and to explore, in a practical manner, ways in which hospital boards could use KC, recognized as a major factor in performance, organizational value, and competitive advantage, for better board decision making.
Research QuestionsSix research questions were asked in the study:
1.    To what extent are hospital board trustees (CEOs, and trustees) aware of KC concepts and terminology?
2.    How is KC, and its components and indicators, (e.g., medical educations audits) discussed by, or reported to, the board, if at all?
3.    Which KC components are or would be most important to trustees, and why are they important?
4.    Are there examples of KC components that made a difference or benefit in this organization or another with which trustees have been associated?
5.    What is the value information related to KC would add to the information (e.g., cash flow, admissions, average length of stay) currently supplied to trustees at board meetings?
6.    If the board on a frequent and regular basis monitored KC, how should senior management present information about KC for optimal understanding and use?
Study Population and Methodology  The Wyckoff study used a qualitative descriptive case study design, and was directed to the nonprofit hospital board decision maker in the New York metropolitan geographic area.  Fourteen semi-structured 30-minute interviews with trustees at 7 different hospitals yielded information on trustee awareness and perceptions of KC, as well as its importance in the context of strategic decision making.  Findings Two areas of the study yielded findings that were significant in the filling of gaps in the research: rankings of KC and financial key performance indicators, and the overarching importance of KC/nonfinancial information when an acquisition of a medical practice was concerned.  In the first instance (KC v. financial KPIs), the research found that trustees ranked half of the 10 top-ranked indicators to be KC, or nonfinancial, in nature: reduction of hospital-originated infections (#1), retention of nursing staff (#2), nurses with a BS degree (#3), patient satisfaction (#6), and # of physicians listed in “NY’s Best Doctors” (#10).
Trustee Archetypes Identified  From these interviews, practice recommendations were made, and five trustee archetypes were developed: expert adviser, operational skeptic, inquisitor, neophyte, and representative.  The Wyckoff study explored the way trustees used the information supplied to them in preparation for each board meeting.  Individual trustee strategies are evident as a series of information-gathering and processing habits.For example, a theme that emerged from the interviews highlighted participants’ access to additional information through inquiry at board meetings, follow up with other trustees and administrators, and relationships with hospital department heads.  For those who used such inquiry as their dominant strategy, an archetype, the operational skeptic, was developed.  A similar case study narrative approach was used to identify and develop the four other archetypes.
Practice Recommendations Ten practice recommendations were made in the study, including: inclusion of additional nonfinancial, or knowledge capital reports and metrics in board material; presentations on transactions (e.g., acquisitions) could contain nonfinancial, knowledge capital information and metrics; encourage more follow up or contact with experts in different areas of the hospital; and gradually introduce and discuss KC indicatorand comparative statistics to develop a board perception of hospital progress within acontext of competitive advantage.
Further Research RecommendationsThree recommendations for future research were made in the study: add the study’s insights into the importance and competitive advantage of knowledge capital to board recruiting strategies; conduct similar research amongst a larger sample of hospital trustees (e.g., Q=100); and develop role-playing exercises to further develop or refine the trustee archetypes identified in the study.
About the researcher  James Wyckoff, DHA, APR, is an educator and award-winning marketing communications practitioner.  He is currently visiting assistant professor of public relations at SUNY Oswego.  He has worked at public relations and advertising agencies, and on the client side with colleges (College of Mount Saint Vincent), hospitals (Hospital for Special Surgery and New York Presbyterian) and home care companies. (Olsten Health Services, formerly the nation’s largest).  He has written speeches for two US Presidents, won an Effie award, and was co-author of the PRSA Code of Ethics and Professional Standards.  He has been published in the peer-judged journal Drug Benefit Trends, on CIGNA’s groundbreaking pediatric asthma disease management program, and is the author of a chapter on “Health Communication Ethics” in the second edition of the Bartlett & Jones textbook, Health Communication


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