A hospital as defined in the Britannica is ‘an institution that is built, staffed, and equipped for the diagnosis of disease; for the treatment, both medical and surgical, of the sick and the injured; and for their housing during this process’[1]. A hospital is one of the oldest institutions in the world. Earliest recorded evidence of a hospital dates to ancient civilizations such as the Mesopotamians, and Egyptians as early as 2000 BC [2]. Nowadays, Hospital or health institutions can be found in every corner of the earth. Between 2000 and 2020, There have been many advancements in the healthcare sector. These advancements contribute to lower global maternal mortality ratio, lower global neonatal and under-five mortality rate, increased life expectancy and lower NCD diseases like the chronic respiratory diseases, cardiovascular diseases, and cancer (WHO, 2023). 

During the pandemic there were many advancements in healthcare. Virtual care made it possible for doctors to diagnose patients via chat or video conference using phones [3] The pandemic made regulations on virtual care loosened and reimbursement was increased [4]. AI and Machine Learning also was able to identify process inefficiencies, forecast outbreaks, and many more [4]. COVID-19 Pandemic also accelerated the development of epidemiological surveillance and contact tracing to individual patient care. COVID-19 pandemic also showcased the collective effort and knowledge-sharing which was crucial to the development of COVID-19 vaccines. Moving forward Knowledge Management (KM), and knowledge sharing will be an important factor for hospital to keep on innovating and be prepared future disruptions.

The subject of this final project is about the Leading Hospital Group Network in Indonesia. This Hospital Group is one of the largest healthcare providers in Indonesia established in the 90s and based in Jabodetabek in Indonesia. The Hospital Group consists of the Head Office (HO) which manages and supervises more than 40 Hospital Units (HU) that sacrificed dozens of hospitals in Jabodetabek, and more than twenty hospitals in Java, Sumatra, Kalimantan, Sulawesi, Bali, and Nusa Tenggara. The Hospital Group is a public company and is traded on the Indonesia Stock Exchange. From 2020 - 2021, the chain achieved high growth from COVID-19 revenue, and despite the drastic decline in COVID-19 revenue in 2022, they still have strong financial performance. The company's revenue in 2022 is more than IDR 9 trillion, and its net profit is more than IDR 7 billion, both higher than the industry average. Their Return on Assets and Return on Equity are 7.35% and both are higher than the industry average as well. Going forward, the Hospital Group will also optimise their operations to be more efficient and continue to explore more automated options to help run the business more efficiently.

All Group Hospital Units follow the Standard Operating Procedures (SOP) of the Head Office. Group Headquarters is the policy and standards maker. Through the Quality and Risk Division, under the Directorate of Quality, Nursing and Training (QNT), the organization manages a digital application for storing, sharing SOPs, regulations, and other compliance checklists that Hospital Units must follow. All Group Hospital Units follow the Standard Operating Procedures (SOP) of the Head Office. Group Headquarters is the policy and standards maker. Through the Quality and Risk Division, under the Directorate of Quality, Nursing and Training (QNT), the organization manages a digital application for storing, sharing SOP, regulations, and other compliance checklists that Hospital Units must follow. GWI scores vary from hospital to hospital. Of the more than 40 hospitals, the average score was 79/100. The highest GWI score was 92/100 from their Surabaya hospital, and the lowest was 67/100 from one of their Tangerang hospitals. Guidelines or regulations for GWI are distributed from Hospital Head Office through various means such as Quality Management System application for SOP, regulations, and checklists to ensure they comply with regulations and SOP made from Head Office as well as standards set by the minister of health for hospitals in Indonesia. Learning from the COVID-19 pandemic, innovation and technological advancements are critical. There are more than 13,000 employees in the Hospital Group. With so many employees, organizations also need to leverage their employees and foster an environment for knowledge growth and knowledge sharing among its employees.

Tacit and Explicit Knowledge

Knowledge can be divided into two types: Tacit and Explicit. Knowledge is tacit according to Polanyi [5] as personal, context-specific, and therefore difficult to formalize and communicate. Hajric explains that tacit knowledge is often referred to as know-how and refers to intuitive and experience-based. Explicit knowledge on the other hand is described by Hajric  as formalized and codified and is sometimes referred to as know-what. Explicit is easier to identify, store, and retrieve.

Figure 1. Conceptual Framework

Figure 2. Research Methodology

SECI Model

In 1996, Nonaka and Takeuchi [6] worked extensively in the concepts of explicit and tacit knowledge. Nonaka and Takeuchi introduced the SECI Model. Based on the two types of knowledge mentioned above, they explained that knowledge types can be combined and converted, and explained how knowledge is shared and created in the organization . Hajric  explained SECI models are constantly being converted and created as users practice, collaborate, interact and learn. He further explained that the SECI model is a continuous and dynamic vortex of knowledge rather than static, and the visual representation shows the overlapping processes that occur or should occur within an organization.

Defining Knowledge Management

Hajric  defined Knowledge Management is the systematic management of an organization's knowledge assets with the aim of creating value and meeting tactical requirements & strategic; It consists of initiatives, processes, strategies, and systems that sustain and enhance the storage, assessment, sharing, refinement, and creation of knowledge. Janus  [7]explained the assets include databases, documents, policies, procedures, and the expertise and experience of individual workers who were not previously captured.

APO KM Framework

To assess the current level of Knowledge Management in the company, the APO Knowledge Assessment Tool will be used. The APO Knowledge Assessment Tool is a survey questionnaire created by the Asian Productivity Organization. It is an intergovernmental organization committed to improving productivity in the Asia-Pacific region. The APO Knowledge Assessment Tool is designed to help organizations conduct a rapid initial assessment of their readiness for KM. The KM APO tool is carried out early in the KM program for organizations to know their strengths, and opportunities for improvement (APO, 2020). The KM APO Assessment Tool evaluates an organization's knowledge management (KM) practices based on seven key areas: leadership, processes, people, technology, knowledge processes, learning and innovation, and KM outcomes.

Conceptual Framework

In this study, a conceptual framework has been created to describe the literature and tools to be used to solve business problems.

In this study, there will be a mixed approach to data collection using quantitative and qualitative procedures. Quantitative and qualitative methods will determine the current performance of Knowledge Management in the Hospital Group. The quantitative method to be used is the APO Knowledge Maturity Questionnaire, and the Qualitative Method used is an interview. For quantitative data collection, an online questionnaire will be used. The only questionnaire will be distributed using Google Forms. This question is based on the APO KM Maturity question by the Asian Productivity Organization. The respondents to the questionnaire were all 34 employees of the Hospital Group, both from the Directorate of Quality, Nursing at the Head Office. For sampling will use purposive sampling to be used. The second part of data collection is qualitative data. The reason for conducting the interview is that it will be more open so as to provide better insight into KM current performance at The Hospital Group as well as suggestions for improvement. The interview will be conducted offline and will take approximately 15 minutes per interview per respondent. The results of the interview will be recorded, and the answers will be made into transcripts which can be viewed in the Appendix.

The author further explores the results of the APO KM Maturity assessment by displaying the results in a radar chart, and table form. The results of the KM assessment will be divided by category based on the seven categories. Once the interview is made into a transcript, the data will then be analyzed. Answers from interviews will be consolidated and grouped into seven categories based on the APO Knowledge Management readiness assessment audit category. Each category will be further analyzed and divided into subcategories: What's good about it, what's bad about, and suggestions for improvement regarding the category. Once you're done analyzing the quantitative and qualitative data, the results will be pieced together using data triangulation to see the whole picture. By triangulating the data, we can determine the current performance of
KM as well as insights from our respondents on recommendations to strengthen weak areas that need improvement.

Quantitative Results Analysis

Based on the results of the questionnaire in figure 4.4, this network of Hospital Groups has received a total score of 161 which makes their KM Maturity level as Refined. Enhanced Knowledge Management means that the Hospital Group realizes what KM is, its importance in increasing productivity and productivity, has begun to recognize the need to manage KM, is implemented throughout the institution, and is continuously evaluated and improved. The Hospital Group, however, has yet to achieve the highest score of 'Maturity' which means KM has not been mainstreamed in the institution.

In terms of current performance ratings, the radar score above indicates that the technology is the highest and closest to a maximum score of 30. The second highest is Process and next is Leadership. In the Center there is KM Results in rank 4. The order of the last three categories from rank 5 to 7 is Learning Innovation, Knowledge Processes, and finally, People.

Qualitative Results Analysis

BF1 – Ensuring Consistently Good Service Standards in All Hospital Units

There are many ways that this organization does to ensure that all their units provide consistently good service standards, despite having many hospitals spread throughout Indonesia. The most common answers gathered from interviews involve having standard SOP developed and shared by the Head Office. This SOP is made by the Head Office using various sources such as national and international accreditation standards. The Head Office has also provided tools such as Quality Management System for Hospital Units to access documents and track their compliance. Not only stopping at compliance, the Head Office Quality Division also routinely visits the Hospital Unit to audit hospitals so that they follow guidelines, regulations, guidelines, and SOP by the Head Office. Lastly, having the right staff with the right qualifications who regularly receive refresher and orientation programmes is also a way the Hospital Group can ensure all Hospital Units can deliver consistent standards of service.

BF2 – The Challenge of Maintaining Quality

Looking at the current condition of the Hospital Group, gathered from interviews, there are several challenges in trying to maintain a consistent quality of service across the Hospital Group. The first challenge was the location and size of the Hospital Group. There are more than 40 hospitals spread across 29 provinces in Indonesia. This large scale increases oversight and makes it difficult to maintain the same quality of service. In addition, each region has different levels of quality of labor, education, technological resources, and socio-cultural background. Another  challenge  is  educating  and  training  more  than 10,000 employees who have different levels of understanding as well depending on where they live. The final challenge is that even though employees have been given training, there are many of them who leave the company entirely, making the company look for replacements and provide them with training from scratch again.

Figure 3. KM Maturity Level Score

Figure 4. Hospital Group KM Maturity Radar Score

BF3 – Hospital Unit Responds to New Knowledge from Head Office

This Hospital Group is a large organization and has many employees working in it with different cultures and backgrounds, however, the answer to this question is quite consistent from everyone interviewed. How employees in Hospital Units respond to shared knowledge is that they won't like new SOP, training, sharing, and so on if they see it as extra work. But in general, interviewees believe that employees feel safe and feel and that Head Office supports and ensures they can work more safely and easily. They understand that SOP, training, sharing, and so on are in their interest as well and they are willing to learn and follow them. However, there is a minority of employees who need to be reminded and more effort to encourage them to want to learn new SOP.

BF4 – Hospital Unit Challenges in Complying with SOPs from Head Office

As mentioned earlier, the function of the Hospital Group headquarters is to standardize and then enforce all Hospital Units to follow suit. The Hospital Unit has created a Group Wide Indicator (GWI) 'As mentioned earlier, the function of the Hospital Group headquarters is to standardize and then enforce all Hospital Units to follow suit. The Hospital Unit has created a Group Wide Indicator (GWI). Not all Hospital Units are unable to do the same, and according to the interviewees there are some challenges but commonly found in Hospital Units to comply with SOP or standards that affect their performance. The first challenge is that the Hospital Group is geographically very large, and the progress is different in each hospital. Employees are very diverse and come from different backgrounds with different cultures. They have different qualities and understanding of SOP. Some staff do not like to read and need to be reminded frequently of SOP and regulations while others are very independent. 

KL1 – Latest Knowledge and Learning Culture in Hospital Group

The consensus gathered from the resource persons will suggest that the learning culture at Group Hospital is good but still needs improvement. Currently, the culture of learning and knowledge in the Hospital Group is better than other Hospital Groups in Indonesia based on existing initiatives. The Hospital Group has invested in building a learning center where employees can learn practical training that enriches their skills and abilities. The Hospital Group has and E-Learning with many modules such as General and Special Orientation programs. Organizations also place training within their corporate goals that require employees to attend a minimum of 20 hours (non-clinical) and 40 hours (for clinical) training.

KL2 – The Impetus for Knowledge Sharing and Interfunctional Collaboration

According to interviewees, Hospital Group employees are highly qualified and sought after in the healthcare industry. However, according to the source, the culture of sharing and collaboration is still far from the minds of many employees. That is why the habit of sharing knowledge and working collaboratively should start from the Hospital Head Office/Group Management. Today, the Head Office accommodates regional meetings between many hospitals at once to share innovations or problems and discuss common solutions. The Head Office has also used a Quality Management System (QMS) using Medblaze for SOP, Guidelines, and Policies for the units to be followed. The training conducted by the Hospital Group is often taught by experts who can staff the Hospital Unit encouraging them to share their knowledge. 

KL3 – Knowledge Store

One of the weaknesses currently faced in organizations is retaining knowledge from employees who leave the group or take sabbaticals. The Hospital Group has a Quality Management System using Medblaze where information is stored there from the Head Office in the form of SOP, Regulations and Guidelines. The Hospital Group has also provided systems such as Shared Folders and encourages all its employees not to store data on their own personal computers, but to upload it online so that it is not lost once employees leave the organization. Employees, especially the more senior ones, are encouraged to have successors if they leave the organization to better retain knowledge. Interviewees believe that knowledge retention is still weak.

KL4 – Good Sustainable Initiatives to Improve a Culture of Learning and Innovation

According to the source, there are many ongoing initiatives currently being implemented in good organizations in increasing the drive of knowledge, innovation, and learning culture in the Hospital Group; 1) The presence of eLearning that provides opportunities for staff to learn independently at any time is invaluable during the pandemic, 2) The Head Office provides a Leader Candidate Program for outstanding employees, giving them the opportunity for them to receive training and advance their careers, 3) Expand the list of training provided from the Training Center to cover every discipline, not just Clinical training, 4)           Sponsorship for employees to receive Bachelor (for Nurses with Diploma degree), Master's, and Doctor Specialty, 5) The Head Office also provides work mobility, providing opportunities for staff to change work areas, 6) Providing regular "Learning Café Events" where the Head Office invites experts to share experiences, 7) Other free webinars and workshops on a variety of topics for staff to participate in, 8) Work closely with universities to conduct research that helps drive innovation. Research is one of the company's Corporate Missions, along with Education, 9) Create an Innovation Competition that can be participated by all employees in the organization. Innovation is one of the company's Corporate Values, 10) Educational videos that appear whenever employees connect to the internet, although they are currently for Information Technology videos only. 

KL5 – Another Initiative That Would Be Good to Implement within the Group

There are many initiatives already undertaken by excellent organizations in enhancing knowledge, innovation, and learning culture in the Hospital Group. However, according to interviewees, there are many opportunities for initiatives that can enhance it even further. Some of the initiatives proposed by the interviewees; 1) A clearer and more transparent career path for employees. There is currently no written career path for employees and the Hospital Group has not collected and maintained a database of staff competencies, 2) Improved modules/courses and journals in eLearning. There are over 100 active courses in eLearning but there is room for more. Most courses are geared towards clinical subjects. Journals are also currently only for nursing, leaving room for other functions as well, 3) The Hospital Group adds more organized knowledge management specific activities that are more consistent that can be integrated in all function.

Analysis of Data Triangulation Results 

The Data Triangulation Method to be used in this chapter is the Methodological Data Triangulation Method. Methodological triangulation involves the use of multiple methods to examine the subject under study, operating in one method (such as different versions of a survey) or across multiple methods (such as combining surveys with observational data collection). The data triangulation below combines quantitative data collected from questionnaires and qualitative data collected from interview.

Table 1. Methodological Data Triangulation Results

Source: Researcher Processed Data 

Table 2. Business Strategy and Solutions

Source: Researcher Processed Data

Business Solutions

The Hospital Group has implemented many Knowledge Management Initiatives that have provided many benefits to the organization. The overall score of KM Maturity Level is 161 which makes the Hospital Group in the Refinement stage. the author then discusses opportunities for improvement based on data collected from questionnaires and resource persons. In this section of the report, the author has provided business solutions that are incorporated into Tables 2 and then divided into 4 Key KM Components that a Knowledge Management strategy must have. The author will also add two columns in the table: Impact and Effort to define the Action Priority Matrix. 

Implementation Plan &; Justification

The Action Priority Matrix in Figure 4.5 below is a summary of the 10 recommendations for the Hospital Group. The Action Priority Matrix is divided into four quadrants with Y-Axis of Impact levels, and X Axis of Effort levels. High Impact and Low Effort are categorized as the most  prioritized   Quick   wins   because   of   high   impact
although not difficult to implement. High Impact and High Effort are categorized as Large Projects, this is also an important action to take because it has a high impact. Low impact and Low effort are categorized as Fill-in and are worth considering because even though they don't have high impact, doing so requires little effort. The last category is selfless tasks, requiring a lot of effort to perform but having a low impact but sometimes still mandatory which is why they are called 'Selfless duty' [1]. 

In the Action Priority above, PR3 must be done first because it is a Quick Win. The second solution that must be done is PP1 which has medium impact but requires low effort. The next set of strategies is part of a Big Project that requires high effort to perform but has a high impact. From rank 3 to 7 they are PP2, GV2, PP3, PR2, and GV1. The next solution that must be done is PR1 which is placed in the Fill-ins category. PR1 has a low impact, but it's still worth doing because it takes less effort to do. Finally, TC1 and GV3 ranked 9th and 10th. They are medium effort but high effort that puts them right above selfless tasks, which is why these two solutions are placed last.

Figure 5. Action Priority Matrix (Plan, 2023)

Table 3. Business Solution Strategy and Analysis

Table 4. KM Performance Gap in Hospital Group Chain

Table 5. KM Strategy to Increase KM in Hospital Group Chain & All Hospital Groups Should Have

This research was conducted to review the current performance of the Leading Hospital Group Network in Indonesia. The collected results are analyzed and below are the three main points:

• The performance of KM Chain Hospital Group is 161 out of 210 which means the difference is 48 points (or 23%) of the maximum score.

• From the interviews and questionnaires collected, there are various challenges faced in the Hospital Group Chain such as: Difficulty in maintaining consistent services due to the geography of Hospital Group Units spread throughout Indonesia which increases the possibility of supervision, different cultures and capabilities of Hospital Units, frequent high turnover, unclear career paths, no formal mentoring and coaching programs,   there is no incentive to cooperate and share information, and there is no KM-specific department

   

The author has analyzed the gaps in KM performance of the Hospital Group Chain and has formulated Business Strategies and Solutions for the Hospital Group. In addition to Business Strategies and Solutions for Hospital Groups, the Author has also formulated must-have KM Strategies that can be followed by other Hospital Group Networks by combining the KM Strategies implemented as well as the Strategies not yet implemented by the Hospital Group Chain analyzed

The author recommends the Hospital Group Chain to implement the strategies suggested in the previous chapter. With the Hospital Group Chain implementing the mentioned strategies, they can achieve better performance, improve the quality of its services, increase productivity and profitability. However, the strategies mentioned are discussed very briefly which provides opportunities for future studies that focus more on individual strategies. Another recommendation for future research is related to the fact that the KM assessment conducted in this study focuses on the Group Network of Private Hospitals in Indonesia. For future research, the author recommends conducting KM assessment at Hospital Group Chain outside Indonesia. Furthermore, the author also recommends conducting KM assessments for government hospitals in Indonesia. The results and strategies at work within a Private Hospital Group Chain may differ from that of government hospitals, or a Private Hospital Group Network in other countries, making future research an interesting topic to undertake. 

1. Scarborough, H., Fralick, P. C. & Piercey, W. D. (2023). Hospital | Definition, History, Types, Services, & Facts | Britannica. [Online] Available at: https://www.britannica.com/science/hospital

2. Mark J, J. (2023). Medicine in Ancient Mesopotamia. [Online] Available at: ttps://www.worldhistory.org/article/687/medicine-in-ancient-mesopotamia/ [Accessed 10 July 2023]

3. Renu, N. (2021). Technological advancement in the era of COVID-19. SAGE Open Med.

4. Laborde, R. & Schlichtig, S., (2022). The COVID-19 pandemic: a catalyst for healthcare technology innovation and transformation. [Online] Available at: https://blogs.oracle.com/healthcare/post/covid-19-pandemic-catalyst-healthcare-technology-innovation

5. Polanyi, M. & Sen, A. (2009). The Tacit Dimension. Revise ed. Chicago: University of Chicago Press.

6. Nonaka, L., Takeuchi, H. & Umemoto, K. (1996). A Theory of Organizational Knowledge Creation. International Journal of Technology Management, Issue 11.

7. Janus, S. S., (2016). Becoming a Knowledge Sharing Organization: A Handbook for Scaling Up Solutions through Knowledge Capturing and Sharing. S.l.:World Bank Group.

8. Plan, P. (2023). What is an Action Priority Matrix? | Definition and Overview. [Online] Available at: https://www.productplan.com/glossary/action-priority-matrix/#:~:text=An%20action%20priority%20matrix%20is,on%20top%20of%20the%20others

9. APO. (2020). Knowledge Management: Tools and Techniques Manual. Tokyo: Asian Productivity Organization. 

10. WHO. (2023). World Health Statistics 2023 A Visual Summary. [Online] Available at: https://www.who.int/data/stories/world-health-statistics-2023-a-visual-summary/