Knowledge Capital and Information
Hospital Trustees Need* is 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
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
QuestionsSix research questions were asked in
what extent are hospital board trustees (CEOs, and trustees) aware of KC
concepts and terminology?
is KC, and its components and indicators, (e.g., medical educations audits)
discussed by, or reported to, the board, if at all?
KC components are or would be most important to trustees, and why are they
there examples of KC components that made a difference or benefit in this
organization or another with which trustees have been associated?
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
the board on a frequent and regular basis monitored KC, how should senior
management present information about KC for optimal understanding and use?
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).
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.
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 indicators and comparative
statistics to develop a board perception of hospital progress within acontext
of competitive advantage.
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.