Abstract:

Public healthcare services are characterized by increased expectations and demands for quality and efficiency, while at the same time the complexity is augmented, and available resources are limited. The situation with a worldwide pandemic, in addition to ongoing as well as upcoming demographic changes, is a reminder of society's vulnerability. It also challenges the way public sector provides and organizes healthcare services.

The major changes characterizing healthcare puts a high demand on digitalization, innovation and to continuous development of new ways of working. A lack of focus on experience, skills, training and knowledge on the one side, and expectations of the technology and its use on the other, are elements that may limit both the potential of digitalization as well as the required development of the services. A prerequisite for innovation and development at the workplace is learning and knowledge development and, in some cases, also a need for unlearning. There is a growing interest and demand for more research on knowledge management (KM) and its importance for workplace learning, innovation and development of new ways of working. Since innovation and learning often take place on the boundary between disciplines and in encounters between people and between people's experiences and knowledge, this paper aims at identifying boundaries appearing in relation to innovation in public healthcare organizations. The paper will also explore ways of managing knowledge across identified boundaries.

The paper is based on research data from a sub-project in a longitudinal study conducted in public healthcare services in municipalities in Norway and Sweden. In the sub-project employees and managers at five municipal healthcare institutions participated in a project where the purpose was to increase the ability to collaborate about the development of future services. Data was collected through interviews with the participants as well as participant observation in different workshops through the sub-project. The interviews were transcribed and analysed using thematic analysis, and the notes from the observations were used as a supplement to the interview data.

The results showed that the participants experienced it challenging to "round up" or prioritize a common challenge/problem to work on. A foundation and involvement of the different organizational levels were seen as a success factor. Being guided into using more systematic methods increased the participants awareness of how working from what you know rather than what you assume have a positive effect when developing knowledge-based practice.

Based on the findings, different boundaries were identified in the process where employees and managers collaborated to increase their ability to innovate and develop future healthcare services. Learning and knowledge are crucial in innovation and development work, but the findings show that learning at the workplace does not happen by itself. Knowledge management is needed to succeed creating a learning environment through transferring, translating and transforming of knowledge.

Keywords:

Healthcare Services, Knowledge Management, Innovation and Development Work, Knowledge Boundaries.