iBusiness, 2011, 3, 30-34
doi:10.4236/ib.2011.31005 Published Online March 2011 (http://www.SciRP.org/journal/ib)
Evidence-Based Investigation for Determining the
Characteristics of Knowledge Management on
Organizational Innovation within Taiwanese
Teaching Hospitals
Chien-Chang Yang1, Chen-Chung Ma2*, Yung-Yu Su3, Patricia Moulton4
1Far Eastern Memorial Hospital, Taipei, Taiwan; 2I-Shou University, Kaohsiung, Taiwan, China; 3Meiho Institute of Technology;
Meiho, PingTong, Taiwan, China; 4University of North Dakota, Grand Forks, USA.
Received December 13th, 2010; revised January 15th, 2011; accepted January 17th, 2011.
ABSTRACT
Knowledge management models assist executives in generating and adopting sufficient information for managerial de-
cision-making. These mod els may have utility in health care systems. This stu dy examined knowledge manag ement and
innovation through the development of a culturally-appropriate instrument and collection of information from health
care providers at several Taiwan teaching hospitals. Results indicated that several dimensions of the knowledge man-
agement model are associated with innovation and sharing of information in the study hospitals.
Keywords: Component, Evidence-Based Investigation, Knowledge Management, Organizational Innovation
1. Introduction
In the knowledge-based economical age, entrepreneurs
who can master the information of evidence-based knowl-
edge management will enhance their competitive advan-
tage. This is especially important in order to ensure that
new products and/or processes are innovative [1].
Healthcare organizations are facing many challenges due
to the rapidly changing global healthcare system in the
21th century. These challenges include spiraling costs,
increasing demands for quality care, and patient safety
issues. Health care professions are knowledge-intensive
professions which place health care organizations in the
position to find ways to manage their information and
knowledge-bases more effectively [2].
There are various forms of knowledge: experiential (tacit),
literature-based (theoretical), and evidence-based (both im-
plicit and explicit). Experiential and literature-based knowl-
edge, provide direction for executives in problem-solving; the
process of scientific methodology can be applied to guide the
process in testing whether the direction generated from expe-
riential and literature-based knowledge is suitable for specific
circumstances. As healthcare management is based on the
process of scientific replication and verification of facts to
generate evidence-based knowledge (EBK) [3], the devel-
opment of theoretical knowledge could provide a framework
for guiding evidence-based knowledge [4]
Health care executives who apply knowledge management
(KM) techniques have utilized an objective method for col-
lecting sufficient information and for generating/estimating
the required supervision information for managerial deci-
sion-making within healthcare administration [5]. Evi-
dence-based decision-making is the focus of knowledge
management which “deals with critical issues of organiza-
tional adaptation, survival, and competence in a rapidly
changing environment [3].”
The KM process can not only positively affect organ-
izational innovation (OI) [6]; it has also been shown that
Taiwanese business with more KM show higher capability
in enhancing OI [1]. However, such evidenced-based in-
vestigation has not been conducted within the Taiwanese
healthcare delivery system, especially in relationship to
patient care issues and EBM in healthcare administration.
As a result, there are two aims of this study: 1) creating a
local culturally appropriate instrument for exploring the
relationship between KM and OI for EBM; 2) recognizing
the key factors of the affects of KM on OI within teaching
hospitals based on the feedback of health professionals .

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational 31
Innovation within Taiwanese Teaching Hospitals
2. Background and Conceptual Framework
There are a variety of different KM models in the litera-
ture. Gloet and Terziovski (2004) described KM proc-
esses as knowledge creation, knowledge transport,
knowledge storage, knowledge distribution, and knowl-
edge sharing [7]. Cui, Griffith, and Cavusgil (2005) in-
dicated that KM consists of three interrelated processes:
Knowledge Acquisition, Knowledge Conversion, and
Knowledge Application [8]. Sandars & Heller (2006)
explained KM is the generation of knowledge, storage of
knowledge, distribution of knowledge, and application of
knowledge [9]. In short, KM could be regarded as an
umbrella term for a variety of interlocking processes.
Effective knowledge management has been presented
as one of the methods for improving innovation; as a re-
sult, innovation could be defined as a new product or ser-
vice, a new production process technology or a new
structure or administrative system pertaining to organiza-
tional members [1]. For understanding and identifying
different types of innovation within organizations, such
issue had been discussed [10]. Accordingly, the classifi-
cation of innovations included technical innovation and
administrative innovation [1].
Based on literature review [6,9,11] and with the current
challenges in the healthcare industry, this study proposed
that the aspect of OI will be affected by KM directly in
health care settings. Accordingly, in order to recognize
the strength of relationship between the aspect of OI and
KM, a conceptual framework and a model with 10 hy-
potheses which was generated for achieving its study tar-
get was displayed in Figure 1.
H1: Knowledge acquires creation will affect manage-
ment innovation positively.
H2: Knowledge acquires creation will affect techno-
logical innovation positively.
H3: Knowledge circulation proliferation will affect
management innovation directly.
H4: Knowledge circulation proliferation will affect
technological innovation directly.
H5: Knowledge storage internalize will affect man-
agement innovation directly.
H6: Knowledge storage internalize will affect techno-
logical innovation directly.
H7: Knowledge application sharing will affect man-
agement innovation directly.
H8: Knowledge application sharing will affect tech-
nological innovation directly.
H9: Management innovation will influence techno-
logical innovation directly.
H10: Technological innovation will influence manage-
ment innovation directly.
Figure 1. Conceptual framework and model.
3. Method
This study used a cross-sectional research design utiliz-
ing a structured questionnaire containing 55 questions
with a likert-type scale from 1 (strongly disagree) to 5
(strongly agree) to recognize health professionals’ (phy-
sicians, nurses, and medical technologists) opinion of
KM and OI within teaching hospitals in Taiwan. The
questionnaire included questions along six dimensions of
knowledge management which are defined in Table 1.
In order to test the initial validity of this instrument, six
domain experts were invited to discuss and revised the
content of this instrument, in order to provide content va-
lidity. In addition, descriptive analysis was performed to
explain the characteristics of study samples; a reliability
analysis was used to explain internal consistency; and an
exploratory factor analysis was used to confirm the valid-
ity of research instrument. A one-way ANOVA was used
to recognize which factors of KM and OI were related to
demographic variables. All these statistical procedures
were performed by using SPSS 15.0 statistical software
package. In addition, path analysis was adopted to explore
the relationships between KM on OI (10 hypotheses) by
using AMOS 7.0 statistical software package.
4. Result
This study was conducted at 25 teaching hospitals in
Taiwan; participants were requested to fill out the survey
instrument anonymously. Of the 375 questionnaires that
were distributed, 228 (60.8%) were completed during 1st
to 21st October 2008. Table 2 includes detailed demo-
graphic information of participants.
The reliability analysis indicated that all of the dimen-
sions had good internal consistency (with a Cronbach’s
alpha of greater than 0.8 [12] (see Table 3).
An Exploratory Factor Analysis (EFA) was utilized to
examine the validity of this instrument. Questions were
determined to be valid (see Table 4) (Questions would
be deleted if the value of community is less than 0.4, the
value of Kaiser-Mayer-Olkin (KMO) is less than 0.70,

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational 32
Innovation within Taiwanese Teaching Hospitals
Table 1. Operational definition of each dimension in this study.
Aspect/ Dimen-
sion Definition Questions
Knowledge Man-
agement
KM as respondents’ perception of acquire creation, circulation proliferation, storage internalize and
application sharing.
Acquire Creation It is tacit knowledge that the expertise is generated by experience whilst immersed in daily practice.
Circulation
Proliferation
It is defined that tacit knowledge distribution is aided by the transfer of experiences to new workers by
mentoring and coaching schemes and to established staff by regular opportunities to share their knowl-
edge.
Storage Internalize It is defined that tacit knowledge is stored in the brains of health care workers but may be made partly
accessible to others once it has been codified.
Application Shar-
ing
It is defined that sharing both explicit and tacit knowledge between individuals and applied to decision
making
Management In-
novation
It involves organizational structure and administrative process; such innovation is indirectly related to
the basic work activities of an organization and is more directly related to its management.
Technical Innova-
tion
It pertains to products, services, and production process technology; they are related to basic work ac-
tivities; could be concerned either product or process.
Table 2. Characteristics of participants.
Characteristic Sample Valid Percentage (%)
Male 49 21.5
Gender Female 179 78.5
<30 58 25.4
31 ~ 40 106 46.5
41 ~ 50 56 24.6
Age
>51 8 3.5
High school 3 1.3
Junior college 47 20.6
Bachelor 137 60.1
Education
Post-graduate 41 18.0
Physicians 39 17.1
Nurses 136 59.6 Position
Medical technologists 53 23.2
Table 3. Results of the reliability examination.
Dimensions Cronbach’s Alpha value Corrected Item-Total
Correlation Cronbach’s Alpha if item Deleted Questions
Acquire Creation 0.87 0.52 ~ 0.71 0.84 ~ 0.86 7
Circulation Proliferation 0.90 0.60 ~ 0.75 0.87 ~ 0.88 7
Storage Internalize 0.86 0.61 ~ 0.70 0.82 ~ 0.84 5
Application Sharing 0.87 0.53 ~ 0.73 0.83 ~ 0.86 6
Management Innovation 0.94 0.67 ~ 0.81 0.92 ~ 0.94 12
Technological Innovation 0.93 0.64 ~ 0.74 0.91 ~ 0.92 13
Table 4. Results of the validity examination and one-way ANOVA analysis.
Validity analy sis
Dimensions Communities KMOBartlett’s test of
Sphericit Factor Loading Variance Explained (%) Eigenvalues
A 0.402 ~ 0.645 0.83 0.000 0.634 ~ 0.808 55.60 3.89
B 0.492 ~ 0.687 0.88 0.000 0.701 ~ 0.829 60.45 4.23
C 0.625 ~ 0.682 0.84 0.000 0.747 ~ 0.826 63.73 3.19
D 0.432 ~ 0.689 0.86 0.000 0.657 ~ 0.830 59.98 3.60
E 0.498 ~ 0.725 0.94 0.000 0.706 ~ 0.852 61.33 7.36
F 0.467 ~ 0.624 0.89 0.000 0.683 ~ 0.790 53.53 6.96
One-way ANOVA
Gender Education Position
Dimensions F valus S ig F valus Sig F valus Sig
A 0.02 0.88 1.29 0.28 1.57 0.21
B 0.02 0.88 1.06 0.37 1.54 0.22
C 0.05 0.83 1.36 0.26 1.14 0.32
D 0.00 0.95 1.25 0.29 1,78 0.17
E 0.21 0.65 0.68 0.57 0.40 0.67
F 0.02 0.88 0.41 0.75 1.07 0.35
A: Acquire Creation; B: Circulation Proliferation ; C: Storage Internalize ; D: Application Sharing ; E: Management Innovation ; F:
Technological Innovation ; *Sig. at 0.05 level

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational 33
Innovation within Taiwanese Teaching Hospitals
and the value of Bartlett's Test is greater than 0.05)
[13-16]. Results of the one-way ANOVA (Table 4) in-
dicated that all dimensions of KM and OI were not sig-
nificantly associated with demographic variables (gender,
education, and position).
In this study, model fit of path analysis was evaluated
by examining the chi-square statistic, the chi-square to
degrees of freedom ratio, the comparative fit index (CFI)
[16]. Goodness of Fit (GFI), Adjusted Goodness of Fit
(AGFI) [17]. And the root-mean-square-error of ap-
proximation (RMSEA) [18]. Detailed examination of
each hypothesis (see Table 5) indicates a significant
positive association between circulation proliferation and
management innovation – then list the other significant
relationships (see Figure 2)
5. Discussion
Reliability and validity analysis indicated that the devel-
oped instrument was an appropriate tool that can be util-
ized for conducting studies of Taiwanese health profes-
sionals to determine the relationship between KM and OI
[1-19]. This study also indicated that Management Inno-
vation is significantly associated with Circulation Prolif-
eration and Application Sharing. Technical Innovation is
significantly associated with Circulation Proliferation,
Application Sharing and the overall concept of manage-
ment innovation. These results will be useful for health
care administration as they explore knowledge and deci-
sion-making models for keeping up with the rapidly
change of global healthcare system in the 21th century.
The path analysis relationships results indicate that
Management Innovation is a moderator variable between
Circulation Proliferation, Application Sharing, and
Technological Innovation. Management Innovation is
indirectly related to the basic work actives of an or-
Figure 2. Results of research hypotheses.
ganization while technological innovation is directly re-
lated to basic work activities. This finding is similar to
Damanpour’s study that demonstrated a “dual-core
model” of organizational innovation; high professional-
ism, low formalization, and low centralization facilitate
technical innovations [10]. In short, results of this indi-
rect relationship relates to a real-world situations within
Taiwanese hospitals because all activities within hospi-
tals are controlled by organizational structure and ad-
ministrative process. These results are similar to Su’s
finding indicating that a hospital’s net benefits will be
affected by its organizational behaviors in Taiwan [22].
6. Conclusions and Suggestion
Based on the results of reliability and validity examina-
tion, this study provided an appropriate instrument to
explore the causal relationships between KM and OI
within Taiwanese hospitals for further study in healthcare
industry. Moreover, the present study demonstrated that
KM was a factor which will affect OI directly based on
Table 5. The results of hypotheses examination.
Hypotheses Standardized regression coefficient Critical Ratio
(C. R.)
H1 -- --
H2 -- --
H3 0.407** 5.104
H4 0.202** 3.465
H5 -- --
H6 -- --
H7 0.360** 4.516
H8 0.298** 5.518
H9 0.469** 10.184
H10 -- --
R2 for Management Innovation was 0.537; R2 for Technical Innovation was 0.777
-- Rejected in revised model; ** Statistically significant (p< α=0.01)

Evidence-Based Investigation for Determining the Characteristics of Knowledge Management on Organizational 34
Innovation within Taiwanese Teaching Hospitals
healthcare professionals’ perspective in hospitals. The
findings of this study have implications for healthcare
administrators as they integrate knowledge management
and organizational models that will develop learning or-
ganizations which reinforce sharing and application of
knowledge throughout the hospitals.
Further research could identify whether this instrument
could be used in different hospital levels or hospitals
with different ownerships in Taiwan. In addition, further
research could include qualitative studies to determine
how hospitals are integrating knowledge management
models and what successes and barriers they are experi-
encing.
7. Acknowledgements
We thank all participants who cooperated and helped us
to fill out the research instrument in the sample hospitals.
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