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The Effect of Knowledge Management in Enhancingthe Procurement Process in the UK Healthcare SupplyChainWafi Al-Karaghouli a , Ahmad Ghoneim a , Amir Sharif a & Yogesh K. Dwivedi ba Brunel Business School, Brunel University, Middlesex, UKb School of Business and Economics, Swansea University, Wales, UKPublished online: 22 Jan 2013.

To cite this article: Wafi Al-Karaghouli , Ahmad Ghoneim , Amir Sharif & Yogesh K. Dwivedi (2013) The Effect of KnowledgeManagement in Enhancing the Procurement Process in the UK Healthcare Supply Chain, Information Systems Management,30:1, 35-49, DOI: 10.1080/10580530.2013.739888

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Information Systems Management, 30:35–49, 2013Copyright © Taylor & Francis Group, LLCISSN: 1058-0530 print / 1934-8703 onlineDOI: 10.1080/10580530.2013.739888

The Effect of Knowledge Management in Enhancing theProcurement Process in the UK Healthcare Supply Chain

Wafi Al-Karaghouli1, Ahmad Ghoneim1, Amir Sharif1, and Yogesh K. Dwivedi2

1Brunel Business School, Brunel University, Middlesex, UK2School of Business and Economics, Swansea University, Wales, UK

This article investigates the gap of diverse knowledge andmisunderstanding between different parties in supply chain pro-curement in two West-London hospitals. The case studies identifiedcommunication as an issue in sharing and transferring the dif-ferent knowledge between the two parties at the requirementsstage and throughout the supply chain management. The devel-oped framework facilitates sharing both tacit medical knowledgeand tacit technical knowledge to be treated as continuous processesin matching requirements and specifications.

Keywords tacit (sticky) and explicit (fluid) knowledge; knowledgerequirements framework; knowledge sharing and commu-nication; supply chain; healthcare sector

INTRODUCTION: WHAT IS IT ABOUT?The healthcare sector encompasses a diverse breadth of tacit

knowledge, which adds to the complexity of knowledge sharing(KS) and transfer amongst the main two parties in the processof medical procurement. On one hand, there is tacit medicalknowledge (TMK) that the surgeon, general practitioners (GP),nurses, paramedics, etc. possess. On the other hand, there isthe tacit technical knowledge (TTK) the suppliers deal with.These different types of knowledge lead to requirements mis-understandings within the two main aforementioned parties.The effect of knowledge management (KM) and procurementin ordering the right medical devices for daily operations areputting pressure on healthcare organizations (e.g., hospitalsand providers of medical devices) to look for opportunities toimprove operational efficiencies and to provide a high qualityof care (Bates, 2002; Hanna & Sethuraman, 2005). Accordingto Beier (1995) and Schneller and Smeltzer (2006), different,highly-specialized medical devices are needed in such opera-tions. These specialized and specific medical devices add to thecomplexity of supply chain management (SCM) in healthcarein comparison to other industries.

Address correspondence to Wafi Al-Karaghouli, Brunel BusinessSchool, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK.E-mail: wafi.al-karaghouli@brunel.ac.uk

Requirements and KM hold the key to this dilemma inthe healthcare environment. KM especially places value onthe tacit knowledge (sticky) that individuals (the diversity ofKM applications in the healthcare sector, e.g., doctors, nurses,paramedics, and IT/IS personnel) hold within an institutionand often makes use of IT to free up the collective wisdomof individuals (intellectual capitals [IC]) within a health orga-nization. This article will explore the nature of KM (Polanyi,1958, 1967) within three contemporary healthcare institutionsand associated organizations. It will provide academics andpractitioners with an understanding of approaches to the criticalnature and use of knowledge by investigating healthcare-basedKM systems (Lee, 2001; Leonard & Sensiper, 1998; Rivard-Royer, Landry, & Beaulieu, 2002). Designed to demystify theKS process and demonstrate its applicability in healthcare, thisarticle offers contemporary and clinically-relevant lessons forfuture organizational implementations. While many KM litera-tures suffer from pitching theoretical issues at a too-technicallevel, we approach the topic from the more versatile “twin”perspectives of both academia and practitioners.

This article attempts to address the following question: Howcan the medical requirements (TMK) be matched with technicalspecifications (TTK), and how can this mismatch be handledbetween the two types of knowledge?

From the above, it is vital to match the knowledge of themedical staff (TMK) and the knowledge of the provider (TTK)in the process of procurement throughout the SCM. In otherwords, these two types of knowledge are tacit (sticky), whichmust be shared and transformed into explicit (fluid). It is rec-ognized that the field of KM is very diverse (Hislop, 2009;Nonaka, 1991; Nonaka & Toyama, 2003, 2005; Polanyi, 1958).Through effective communication, the understanding of medi-cal devices’ needs, collaboration between the healthcare sector,and procurement/supply chain industry (AT Kearney, 2004;Beier, 1995; Camuffo, Romano, & Vinelli, 2001; Christopher,2004; Slack, Chambers, & Johnston, 2010) will enable themto provide the right expertise in matching different KM toimprove SCM and its application in areas related to SC procure-ments in healthcare (Harland, Lamming, & Cousins, 1999). KMholds the key to this dilemma in the healthcare environment,

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36 W. AL-KARAGHOULI ET AL.

placing value on the tacit knowledge (that individuals holdwithin an institution) and often making use of information tech-nology systems/knowledge management systems (ITS/KMS)and SCM to free up the collective wisdom of individuals withinan organization.

This research study is designed to demystify the KM process,demonstrate its applicability in healthcare, and offer contem-porary and clinically-relevant lessons for future organizationalKM, KMS, and SCM implementations. In addition, the arti-cle contributes and reflects on the diversity of KM applicationsin the healthcare sector as many KM literatures suffer frompitching theoretical issues at a too-technical level (Bates, 2002;Fisher, Neve, & Heritage, 1999; Shah & Robinson, 2006).

The Goals of This StudyThe article will explore the nature of different types of

knowledge, the role of KM, and procurement within healthcareinstitutions and related organizations (i.e., healthcare KMissues; Nonaka & Konno, 1998; Polanyi, 1967; President andFellows of Harvard College, 1998). The article aims at provid-ing academics and practitioners with an in-depth understandingof approaches to medical devices’ strategy of acquisition andusage in clinical environment as well as the technical knowledgeused by different parties within the healthcare-based KMS. OurKM approach to the healthcare issue will be from the more ver-satile “twin” perspectives of both academics and practitioners.This article is integrative in nature in managing and developingKM (Hawryszkiewycz, 2010; Hislop, 2009; Jashapara, 2011)and SCM (Christopher, 2004; Harland et al., 1999; Slack et al.,2010) that are underpinned by theory and research.

This article seeks to establish the reasons for what can bestbe described as a disappointing track record with the develop-ment of new procurement projects in the public sector, assessthe field research (Marble, 2003), and identify the problemdomain in the areas of KM, KS, and supply chains (SCs) in thehealth sector in the UK (Bali & Dawived, 2006). This articleaddresses the issue of the KS process, and is not an in-depthdiscussion on KM’s structure (Liebowitz, 1998, 1999, 2001;Liebowitz & Beckman, 1998). Therefore, from reviewing pub-lished literature and observing the project failure situation (Al-Karaghouli, AlShawi, & Fitzgerald, 2003, 2005; Bocij, Chaffey,Greasley, & Hickie, 2003; Burke, 2003; Castka, Bamber, Sharp,& Belohoubek, 2001; Irani, 2002), a hypothesis is put forwardto establish the existence of gaps of knowledge and understand-ing during the crucial initial healthcare requirements stage ofthe system developments (Kotonya & Sommerville, 1998; Lin& Shao, 2000). This leads to the need for further investigatingof the topic, and exploiting the reasons behind it. The topic ofproject failures and initial healthcare requirements (Kowalski,1986; Lyytinen & Hirschheim, 1987; Gubbins, 2001; Levinson,2001) has been of interest to researchers for many years. Thistopic was observed and is part of our teaching and research

areas. Also, such interest is shared by other academics and prac-titioners within the British Computer Society (BCS), HealthInformatics (BSC), and the Sociotechnical Group.

RELEVANT LITERATURE: PROJECT FAILUREIN THE PUBLIC SECTOR

The concept of project failures in many disciplines (SCin particular) has been the focus of a considerable body ofresearch for the last four decades (Bates & Slack, 1998; Dyer& Nobeoka, 2000; Fiala, 2005; Lee & Billington, 1992; Tarokh& Soroor, 2006; Turner, 1993). However, there is a limitedacademic investigation on how and why such failures occurin an SC context. The breakdown of communication betweenthe different parties within the procurement process has ledto dysfunctional SCM (Lee & Whang, 1998; Narsimhan &Jayram, 1998 ; Fernie, Green, Weller, & Newcombe, 2003;Hult, Ketchen, & Slater, 2004; Jasumiddin, Klein, & Connell,2005; Knight, Harland, Walker, & Sutton, 2005; Rai, Robinson,Patnayakuni, & Seth, 2006; Qile, Gallear, & Ghobadian, 2011).

The National Health Service (NHS) in the UK is not alone.Arnott (2004) reported that the termination of a £90m equal-ity delivery system contract to develop a national e-mail systemfor 1.2 million made the NHS hit the national and professionalnewspapers. Also, according to Arnott (2007), no other publicsector technology program, however controversial, has gener-ated quite the same furore as the £12bn National Programmefor NHS IT (NPfIT), which conceded with one of the directors,Richard Granger, stepping down. The NHS SC provides con-tracts and logistics for 600,000 product lines. According to theNHS (2011), it is worth noting that 30% of a hospital’s bud-get has been spent on procurement. The NHS aims to achieve a£1.2bn in efficiency savings through improved procurement.

Over the last two decades, a vast amount of literaturehas investigated both theory and practice of SCM. However,McKone-Sweet, Hamilton, and Willis (2005) argued that therewas a limited academic literature that addressed the challengesunique to healthcare organizations. Christopher (1998) arguedthat SCM could be outlined as “the management of upstreamand downstream relationships with suppliers and customers todeliver superior customer value at less cost to the supply chainas a whole” (p. 5) It is worth noting that effective SCM is crucialto maintaining the competitiveness of organizations, especiallyin healthcare (Brennan, 1998; Mentzer, 2004).

There is a growing need to better understand the broadissues of “medical” procurement, management of the SCs, andtheir relationship to the user and procurement process (Slacket al., 2010). The aim of this article is to explore and toprovide answers to the KM issues surrounding medical pro-curement, including ITS and component-based development,as well as gain insights into the theory and practice of SCM(Altricher & Caillet, 2004). The healthcare sector incorporatesa variety of organizations: public-sector providers, governmen-tal departments, private healthcare systems, and not-for-profit

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KNOWLEDGE MANAGEMENT IN THE UK HEALTHCARE SUPPLY CHAIN 37

organizations. It is also incredibly knowledge-intensive, and thecomplexity of healthcare provision only increases as the indus-try’s knowledge base broadens (Nonaka & Von Krogh, 2007).In addition, heightened levels of public expectation and mediascrutiny add to the pressure to perform as efficiently and effec-tively as possible while maintaining an acceptable degree oftransparency and accountability.

It is therefore not surprising that KM is receiving so muchattention from the industry. Public-sector and privately-fundedorganizations alike are turning to KM as a means to help themcope with day-to-day demands and increasing industry frag-mentation. The aims of this article are firstly, to develop a the-oretical framework to bridge the gaps between different typesof knowledge; and secondly, to establish business healthcarerequirements (BHR) and the flow of information in SCsbetween beneficiaries and solution providers in the long andcomplicated SCs of the UK’s Health Sector (Slack et al., 2010).

Based on the review of the normative literature, and due toprior initial contact and discussions with senior members of themedical body, a hypothesis has been established in the viewthat the problem of NHS project failures (especially informationtechnology systems [KMS/ITS]) might be caused by defectedor non-functional healthcare requirements (Lakshminarayanan,2007). The project features could be improved by the capture offunctional requirements (smart requirements) as a valid area ofresearch. The basic hypothesis that BHR are different from tech-nical specifications (TS) (Hanna & Sethuraman, 2005; Kelly,1999; Macaulay, 1996; Polyani, 1967), that is, they are not thesame, is true. Within BHR, the nature of knowledge is TMK,possessed by medical staff within their different roles. On theother hand, within TS, the embedded TTK refers to the SCMsuppliers’ knowledge with reference to the medical devices theyprovide to the healthcare sector. This relationship is shown inFigure 1, and the technical expertise by itself is not the answer(Watson, 2004a, 2004b). It is the sociotechnical approach thatcounts and not the technical approach by itself.

On the other hand, it is not only the healthcare that sufferedfrom SCM project failure. Some major SC operations/systemsin the private sector of the UK have been abandoned. Rigby(2004a, 2004b) reported that Sainsbury had to write-off £140magainst an unsuccessful IT system and £120m with regardto ineffective SC equipment (Gattorna & Walters, 1996;Macalister, 2005). The main reason given to the £140 write-off SC system was “purely a financial matter” according toSainsbury’s IT director Maggie Miller (Fernie, 1995; Knights,2005a, 2005b; Knowledge Management, 2004). This is despitethe dominant market position enjoyed by the retail organizationsand the vast investment they devoted to technological advance-ment over a long period of time (Foremski, 2004a, 2004b; Slacket al., 2010). Some cases of ITS and KMS failures are unheardof in the private sector due to many reasons, including loss offaith. According to Fielding (2003), the private sector (includ-ing the retail industry) can learn so much from ITS projects ofthe public sector (Parker, 2000; Timmins, 2004). Other factors,

according to Glick (2004), are exemplified by the Europeanbusiness organizations which alone wasted £4.05bn (C6bn) onpoorly outsourced contracts in 2003. Gartner’s (2004) researchstudy regarding IT outsourcing shows that 80% of the outsourc-ing IT contracts in India and China were unsuccessful, includingin some cases catastrophic failures due to the cancellation of theservice, poorly managed contracts or re-negotiated contracts.Hence, customer satisfaction with outsourcing fell from 81%in 2001 to 50% in 2003 (Glick, 2004).

This practical article provides a contribution on how togather healthcare and business requirements, from first identi-fying medical business needs to structuring the beneficiaries’requirements (user requirements document and the user accep-tance “test-drive” of the medical equipment). Participants (ben-eficiaries and providers) have to play the parts of stakeholdersand requirements engineers in a system development project towork out what they seek in terms of practical operational sce-narios. In the UK NHS, the only way to ensure a quality medicalproduct is to make sure it meets beneficiaries’ original require-ments (Lauer, 2004; Lewis, 2000; McKone-Sweet et al., 2005).Consequently, there is increasing interest in the use of practi-cal techniques for successfully translating business process andobjectives into systems (Davies, 2002). The use of requirementsand test plans is well understood, but the use of scenarios orcases to obtain these is less familiar. There is a parallel needfor a way of capturing requirements that is compatible with an“object view of the world” (Maiden, 1998).

Setting Out: The Proposed Theoretical Frameworkto Bridging the Knowledge Gap

The main part of the research study focused upon the devel-opment of IS/KMS in the NHS organizations and the significantissues of requirements elicitation and specifications. The imple-mentation of such system in an NHS organization is verycomplex (Roark, 2005), which led us to propose easy buteffective and relevant pictorial techniques and tools. The rela-tively limited literature examining SC (Colletti, 1994; Fenies,Gourgand, & Rodier, 2006; Jarrett, 1998; MacVaugh, 2007;Schneller & Smeltzer, 2006) shows a general agreement thatthe management of healthcare SC is complex.

This article will refer to both the “solution providers” andthe “commercial brokers” as “suppliers.” The emphasis on thebeneficiary’s business knowledge and acquired knowledge isvery important. On the other hand, the supplier’s technicalknowledge is also important, but the knowledge the two groupspossess are different. This will lead to a mismatch betweentheir understanding and interests, which in most cases con-tributes to the failure of projects. Glass (1998, 2001) highlightedthe importance of learning from failures, and the vital need ofthe suppliers to clearly understand the beneficiary’s require-ments. We take a slightly broader view in that we considerthe problem not only being that suppliers often fail to under-stand the beneficiary’s business and needs, but that beneficiaries

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38 W. AL-KARAGHOULI ET AL.

Beneficiary’s Requirements

Medical specialists

Intellectual &Professional Culture

Clash Gap

(Knowledge and

Understanding

Mismatch)

Supplier’s Specifications

SC Provides

Tacit/sticky

Technical Knowledge (TTK)

(Medical Requirements ≠ Technical Specifications)

(TMK ≠ TTK)

Tacit/sticky

Medical Knowledge (TMK)

FIG. 1. A culture clash: TMK vs. TTK (color figure available online).

in turn often do not sufficiently appreciate the realities ofproject development’s processes, or what the project people areoffering.

The theoretical framework to be used for the purposes of thisresearch has been developed based on an extensive review ofthe literature. The proposed theoretical framework presented inFigure 2 comprises two main stakeholders (actors, i.e., bene-ficiary, solution provider) and provides a detailed mapping oftheir roles and activities during the SC process, as illustratedin Figure 1. The extended and proposed theoretical framework(Figure 3) is illustrated by two main sets of environments,namely frameworks of KM and SC implementations (Camuffoet al., 2001). Related issues are knowledge gap (KG), under-standing gap (UG), effective communication, share, and transferknowledge (gathering and implementing requirements are peo-ple issues and not technology issues). It is suggested that thereare explicit knowledge linkages between the main three peoplein the initial requirements stage.

Figure 2 clearly illustrates that within the RequirementsCommon Knowledge Environment (RCKE) of medical devicesprocurements, there are different gaps which need bridging.There has been much talk of a “gap” or “gaps” between bene-ficiaries and suppliers and commercial brokers in procurementsincluding ITS development, but no attempts have been made inthe academic literature to critically address the gaps. We iden-tified two elements to these gaps. It is suggested that there is apotential for a KG and a UG to exist between the beneficiaryand the supplier. The beneficiary’s knowledge is mainly “busi-ness” knowledge with limited or non-techie knowledge. On theother hand, the supplier’s knowledge is “technical” knowledgewith limited business knowledge. The gap between the benefi-ciary and the supplier developer can be bridged if we have morespecific information about the beneficiary. The KG is essen-tially the mismatch of knowledge that the customers typicallyhave concerning IT capabilities and limitation. The hypothesisis illustrated in the diagram.

FINDING OUT: METHODOLOGYThe concepts and techniques suggested in this article are

based on a case study approach of business organizations in theUnited Kingdom and their use of KMS/ITS/SCM (Yin, 2009).The main focus of this research study was in relation to theNHS sector that depends on large procurement and ITS projects,which typically suffers from the legacy of different develop-ments of hardware and software being added to existing systemsover a long period of time. Furthermore, the research will caterfor the current level of SCM in two healthcare organizations.The human influences and involvement in the development ofKMS/ITS are difficult to measure in the conventional sense ofproductivity improvements, but the issue could be addressedby both quantitative and qualitative study of cases that inter-pret productivity in a boarder sense than is conventionallyfound. The main objective was identifying particular featuresthat either inhibit or facilitate the success of the requirementidentification process.

To understand the contribution of system failures, require-ments, and diversity of knowledge in the NHS to the efficiencyof future ITS, efforts were made to establish primary sourcesand find secondary sources that would help. Contacts weremade via e-mail with appropriate well-known authors and“gurus” in these areas, and questionnaires followed up by phonecalls were used to fill gaps in some of these. Secondary sourcessuch as textbooks, journals, and articles of professional publi-cations such as Computing, Computer Weekly, IT Week, pressreleases, and the Financial Times-IT surveys have also beensearched and consulted.

Using qualitative methodology by conducting interviewsover a period of three months, the article addresses two mainthemes (TMK and TTK, i.e., business requirements KM andthe SCs in the NHS sector). The article uses a realistic exam-ple project to work through the required operational scenarios.The participants (beneficiaries and providers) worked as a groupof stakeholders. From the scenarios, they had to write down

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KNOWLEDGE MANAGEMENT IN THE UK HEALTHCARE SUPPLY CHAIN 39

Requirements Common Knowledge Environment

(RCKE)

Beneficiary Solution Provider (Gaps)

FIG. 2. Conceptual model of bridging the knowledge gap (RCKE).

Supply Chain Dynamics: Misunderstanding Communications

Beneficiary

(End-user)

Information Flow

Physical Flow

WholesalerSupplier Manufacturer Retail Store

Sales from

store

Manufacture’s orders

to its suppliers

Store’s orders to

wholesaler

Wholesaler’s orders

to manufacture

Knowledge

Sharing &

Transfer Phase

Supplier’s SpecificationsSC Providers

Tacit/sticky

Technical Knowledge (TTK)

Intellectual &Professional Culture

Clash Gap

(Knowledge andUnderstanding

Mismatch)Beneficiary’s Requirements

Medical Specialists

Tacit/sticky

Medical Knowledge (TMK)

(Medical Requirements ≠ Technical Specifications)

(TMK ≠ TTK)

Knowledge Management Paradigm: Tacit Medical Knowledge (TMK) vs. Tacit Technical Knowledge (TTK)

NHS Needs

FIG. 3. Framework of the relationship between KM and SCs paradigms in the NHS (color figure available online).

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40 W. AL-KARAGHOULI ET AL.

the main requirements in a way that made acceptance testingclear from the start (Collis & Hussy, 2003). Many workshopshave been conducted between the beneficiaries and solutionproviders. These workshops use and adapt simple techniquesbased on “pictorial techniques and tools from both the man-agement science and IT/IS areas” to identify exceptions andother scenarios, and structure these in a way that users canimmediately understand, such as

• A top-level scenario describing the overall approach tothe problem (see Figure 2)

• Detailed scenarios to solve each sub-problem, includ-ing handling expectations (see Figures 1, 4, and 5)

• The outline of the beneficiary’s requirements and theuser acceptance test documents

Participants have learned how to

• Identify the types of beneficiary for the system• Find out from each type of beneficiary what scenarios

they are involved in• Make an effective document structure from the

scenarios

BR

Beneficiary

SS

Supplier

FIG. 4. Initial overlapping of BR and SS.

BR1

BR2

BR3

BR4

BR5

BR6

BR7

BR8

BR9

BR10

SS1

SS2

SS3

SS4

SS5

SS6

SS7

SS8

SS9

SS10

FIG. 5. First stage mapping diagram.

• Locate misunderstanding, errors, exceptions, andmissing scenarios

• Build beneficiary requirements from scenarios• Construct and trace test cases from scenarios

An integral part of the article will be a discussion on the keyresearch issues from a beneficiary (user) perspective, drawnfrom the practical experience and theoretical underpinningshared by the researchers.

Business Requirements Engineering (BRE) is the branch ofsystems engineering concerned with the goals, desired proper-ties, and constraints of complex systems, ranging from embed-ded software systems and software-based products to largeenterprise and sociotechnical systems that involve softwaresystems, organizations, and people.

MAKING OUT: METHOD OF RESEARCHIn this section, the data collection process will be explained

in detail with regard to the two case studies.

Data CollectionThe evidence presented in this article has been generated

through a total of 33 interviews which were conducted withdiversity of medical practitioners, followed by three furthermeetings to gain in-depth understanding of the research prob-lem. Table 1 shows the role and number of interviewees (con-sultants, doctors, senior nurses, senior administrators, operationmanagers (SCM), and IT/KMS senior managers) of both casestudies and on which the data collection process was based.

The data for this research was collected from two case stud-ies conducted in two NHS hospitals in the United Kingdomover a twelve-month period. Qualitative data collection meth-ods were adopted through the use of semi-structured interviewsalong with observations and collection of supporting docu-mentation leading to data triangulation (McCracken, 1988).The interviewees were beneficiaries (consultants, senior doc-tors, senior managers, middle managers, and senior nurses) andsuppliers (devices and ITS senior managers and middle man-agers) from the different departments within the organizationsunder study. The data confirmed the validity of the proposedframework and enabled insight to be gained into other issues ofparticular importance to the initial requirements stage.

The qualitative data analysis process used two levels of cod-ing (Sekaran, 2000; Bryman & Bell, 2011). The first level wasused to identify themes, units of meaning (words, sentences,etc.) as the interviewees expressed them (Figure 4). The sec-ond level of coding refined and reformulated the themes andunits of meaning into more theoretical words (Figure 5). Theaforementioned resulted in a model of understanding by look-ing for coherence and mapping of both business requirementsand supplier specifications.

It is not the purpose of this article to discuss the full findingsfrom this study and how they relate to the overall performance

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KNOWLEDGE MANAGEMENT IN THE UK HEALTHCARE SUPPLY CHAIN 41

TABLE 1Details of medical staff interviewed at the two case study hospitals

Case Study 1 interviewees Number Case Study 2 interviewees Number

Consultant 2 Consultant 2Doctor 2 Doctor 2Senior nurse 7 Senior nurse 4Senior administrator 2 Senior administrator 2Operations manager 2 Operations manager 2IT/KMS senior manager 3 IT/KMS senior manager 3Total 18 Total 15

of project development. However, we will summarize the find-ings that relate directly to the requirement (TMK) identificationprocess. It can be stated that in general, the replies receivedfrom the business (beneficiaries) side and the techie (suppli-ers and commercial brokers) side were significantly different,with the beneficiaries and the suppliers in many procurementorganizations (60% of cases) having very different views con-cerning requirements and the requirements determination pro-cess. Of the rest, 36% generally showed varying degrees ofdisagreement. Only 4% of the cases revealed a situation ofgeneral agreement. What makes these results significant is thefact that at the time of the survey, 60% of these organizationswere either undertaking or about to get involved in some kindof project development. Analysis of the gathered data (particu-larly from the interviews) revealed wide gaps in the customers(beneficiaries) side knowledge, both in the technology and theprocess, concerning how their requirements could be realizedinto finished products. Thirty-five percent of the interviewedmanagers were categorized as generally having poor knowl-edge, 55% as fair, and only 10% as good or very good. On theprovider side, the findings were even more dramatic when itcame to knowledge of specific (and even general) SCM busi-ness operations. Sixty percent were categorized as having verypoor or poor knowledge, 25% as fair, and only 15% as good.No one was categorized as very good. Further, there were clearinstances of “accusations” made between the parties indicatingthe degree of misunderstanding between customers and devel-oper, and vice versa. Clearly, there were significant indicationsin the findings supporting the hypothesis that there is a KG anda UG between the two parties.

Using Scenarios to Identify Knowledge and RequirementsEffectively

Following the analysis of the data collected during the inter-views, a framework (Figure 3) was developed to illustratethe key stages in the procurement and the inventory pro-cess between beneficiaries (doctors, surgeons, senior nurses,and senior administrators) and the providers of the medicaldevices. Furthermore, Figure 3 represents a powerful concep-tual model, linking both the sub-sections in the conceptual

model of the KM and SC in the UK Health sector, which isbased on the research study that gaps in knowledge and under-standing will lead to certain types of project failures (Holden,2002; Rigby, 2004a, 2004b). The discussions and dialoguesbetween the different stakeholders represented in Figure 1 arenot standard. The dialogues are action research which is theoutcome of active participants (different people, i.e., beneficia-ries and providers) to establishing smart requirements. Thesepeople are not affected by market forces (Levitt, 1983), but bythe needs of local individuals and their individual (personal)needs.

In such discussions and dialogues, there are “businessspheres” and “technology spheres.” This is due to the differentstakeholders, and the aim is to engage the above two spheresto create a new explicit knowledge (Figures 1 & 3). This newknowledge is not designed or an outcome of standard method-ologies and theories, but it evolves through the dialogue thattakes place between the two spheres, business and technology(Svensson & Nielsen, 2006). Action research has changed fromexperimental (classic) to dialogical innovation (Ernst, 2002;Gollan, 2005). Action research is a process which includesresistance and a change of perspective of both business andtechnology individuals who are involved in determining smartrequirements. It can be seen that there are commonly identifiedareas which contribute to some SC projects’ goals, and that itis people who are the main factor, so it is necessary that theworking environment is right and that people are managed in away that “brings out their best” (Mintzberg, 2004, p. 12), thusimproving morale and commitment, while encouraging them tomanage the organization’s processes in a way that will increasethe level of performance and achievement.

Our framework above (Figure 3) states that there are twoparadigms. The first paradigm represents the specialists’ TMKof the different stakeholders. The second refers to the TTK ofthe SCM providers, and the third represents the communicationsbetween the two main parties (i.e., beneficiaries and providers),through which different types of tacit (sticky) knowledge areshared and transferred KM, and KMS. As mentioned above, thelatter holds the key to this dilemma in the healthcare environ-ment. KM places value on the tacit knowledge that individualshold within an institution and often makes use of ITS/KMS and

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SCM to free up the collective wisdom of individuals within anorganization.

The view of two cultures, that of providers and the bene-ficiaries, is in evidence in many organizations. The culture ofproviders is typically technically-oriented and is based on anunderstanding of technical issues (Kavanagh, 1998; Grindley,1992). In a procurement project development, this is reflected ina focus on issues such as the functionality of the device/system,its performance, and the response rate (Sturt, 2000; Flood,2000). On the other hand, the business culture and focus israther different and is more concerned with business issuesand the system as support for business and management pro-cesses. These two cultures have been identified by many (e.g.,Cavell, 1999; Griffin, 1998; Nuseibeh, 1996; Sabbagh, 1999;Sommerville, 2004). However, we go beyond this and identifytwo elements to the gap.

In terms of ITS suppliers, the business culture typicallyviews the ITS department as a cost center rather than an invest-ment and contributor to the success of the organization. As aresult, beneficiaries and providers have different expectationsof each other and particularly of any system to be developedwhich is not just about following rules and procedures but musttake into account these differing cultures (Howard, 1999).

The Professional Culture Gap: Communications is the KeyThe main lesson we have learned during this research study

is that communication is the key to KM (communication withsurgeons, doctors, nurse, paramedics, senior management, andpatients; SC providers; within the NHS Information Authorityto ensure there is no duplication across projects; and with theDepartment of Health to make certain the work adheres topolicy guidelines).

We suggest that there are frequently a KG and a UG thatexist between the beneficiary and the supplier. We believe thatthis gap is a result of the different backgrounds, experiences,and working environments of the groups with both sides talkinga “somewhat different language.” Further, we identify a UG,which is to some extent a result of the KG, but is a whole setof differing understandings, meanings, assumptions, and values(see Figures 1 and 4).

It is argued that the view of two cultures is in evidence inmost organizations, although it is true that some organizationshave made efforts to overcome these different and conflictingcultures, usually by trying to mix the participants in “seamless”teams and by co-location of the two groups when developingprojects (Figures 1 and 4). This can help, but the differences arestill deep-seated and not easily resolved. For the purposes of thisarticle, we shall assume that there are two separate groups ofpeople involved. We believe that the determination of clear andadequate understanding of the requirements is a sociotechnicalprocess and that human communication and interaction areimportant ingredients in determining effective requirements.Intensive and sustained communication between the beneficiary

and the solution provider lead to a clearer understanding of therequirements and are likely to result in a better and more use-able system for the beneficiary (Lipnack & Stamps, 1997). Itis also likely to improve the situation if the requirements areright the first time, that is, before any development is under-taken (Lee, Trauth, & Farwell, 1995; Lee, So, & Tang, 2000).This is not to say that we believe requirements are always“out there” waiting to be discovered. Often the notion of a fullset of requirements existing in the minds of the customers isjust not true. Frequently, the customer has to learn and evolvetheir understanding of the requirements as part of the elic-itation process, particularly in complex and new applicationareas.

High and unrealistic expectations of a project prior todevelopment are well-known problems and can contributeto disenchantment with the system when it is implemented.Beneficiaries can get too enthusiastic about technology andhopelessly over-estimate the technology’s capacity to changetheir world. If both groups initially agree on practical require-ments and understand what the system is going to do when it isbuilt, then their expectation will match the system performance.On the other hand, if both groups fail to discuss and evolve thefunctional requirements, then this kind of mismatch of expec-tations is a possibility. Hence, it is clear that communication isthe key in solving a potential culturally-driven mismatch.

OUTCOMES: FINDINGS AND DISCUSSIONTo begin, it is important to understand the flows of interac-

tion among SC partners. As previously discussed, SC partner-ships are formed on the basis of a certain level of mutual inter-dependence and understanding. Initial investigations revealedthat most of the data this research required were already col-lected within the NHS. However, some data were held byhealth authorities, some by NHS trusts, and some sat in nationaldatabases attached to other programs. At the start of the researchstudy, we identified several sources of data and set up the chan-nels of communications to manage the process of collating andmaintaining the data and the information.

First, we established links and set up meetings. Also, somedata and information were provided through a web editor whois a designated person in every NHS organization responsiblefor supplying data to nhs.uk. Some organizations chose to havemore than one web editor for different types of data. The NHScurrently has over 1,500 web editors throughout England. Webservices are already in place to allow the data to be downloadedfrom the web site. This area also allows organizations to exporttheir data so they can make use of all the stored informationwhen they need to. Once the import web services are in place,web editors will be able to choose where they keep their singlesource of data. They can either opt to keep their own databaseup to date and use the web services to upload the data to nhs.uk,or keep nhs.uk up to date and download the data when they needto use it locally.

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The Sociotechnical FactorOther researchers believe that professional culture issues

(social and human factors) contribute significantly to the bigproportion of failures. Walsham (1992) argued that the highdegree of failures in organizations is due to an over relianceon management science techniques, which are inadequate ontheir own. This led to the mix techniques used in this researchstudy. We argue that a sociotechnical approach, wherein amatch between human (social) and technical factors is sought,is fundamental to the design and implementation of organiza-tional change. This research study agrees with Mackenzie andWajcman’s (1985) study of the social influences upon ITS. Theycriticized the idea that an ITS can be “invented” as a singleinspiration in isolation of the influence of existing practicesby noting that historical analysis allows the benefit of hind-sight to trace a particular invention back to a single inspirationalsource. In reality, competing projects may have overlapped andbeen developed concurrently, but only the story of the “win-ner” survived the passage of time. In support of this claim,we cited Ogburn and Thomas (1922), who argued that techno-logical developments were an inevitable result of the synergycreated as innovators merged technological capability and con-temporary artefacts within new context. A number of authorshave supported this theory, notably Hughes’ (1979) analysis ofthe development of electricity. By regarding both technologicalcapability and human influence as central to the innovation pro-cess, this viewpoint discredits a more deterministic account ofthe impact of technology which was reviewed above.

KG Identification: Use of Set DiagramsThe technique that we shall illustrate is the use of the set

diagram (or Venn diagram) and how it can be applied to theunderstanding of the medical profession requirements and theminimization of the gap. Set diagrams have been used success-fully for some time in management science (Anderson et al.,1995), as well as, of course, in their traditional areas of logicand math. It may seem strange that mathematical techniquesare being used in requirements gathering, but they are usedmainly for their graphical representation to drive the require-ments understanding process. They have been found to behighly effective as graphical or pictorial techniques for illus-trating gaps in understanding that exist at the requirementsstage. The diagrams essentially illustrate the degree of overlapbetween the two parties in their understanding of requirements.They are extremely easy to understand and can be manipulatedby both sides to make particular points. For example, by re-negotiating the overlaps, it is easy to indicate how good or badcurrent agreements are on particular matters. Although the setdiagram has quantitative antecedents, it is used here in the con-text of a sociotechnical approach and applied as a driver of asociotechnical process.

The Use of Set Diagrams as an EnablerThe example used below is a representative sample taken

from real-life testing of the technique that was undertaken intwo of the participating organizations. One was the well-knownbusiness organization (NHS beneficiary), and the other was theretail arm of supplier, both based in London.

The circle and octagon of the set diagram in Figure 4 repre-sent different areas of knowledge and understanding; the formerrepresents the understanding of the suppliers reflected in this setof requirements (SS), while the latter represents the beneficiary(BR). The matching or common understanding of the require-ment is where the two circles overlap (BRSS). It is a purelyillustrative example of the situation and the processes.

The above diagram clearly illustrates that in this case thecustomer and the developer have different perceptions andunderstandings of what the system is to deliver and what it willbe like, as the area of overlap is very small.

In this case, the common understanding (overlap) is rela-tively small. The common factors are that they are both talkingabout an internet channel and that the existing processes will beutilized, which will obviously make them a close fit to the newsystem. The overlapping sector is represented by BRSS. Forexample, the customers want the system to be “totally secure,”whereas the developers indicate that they believe total securityis difficult to achieve, and are talking about a mirror system.This clearly shows an area of mismatch or misunderstanding(possibly on both sides), and in set diagram terms there is nomapping between the two sets in terms of security. Anotherexample of a mismatch is that the customers want the system toattract new customers, but this does not seem to have been takenon board in any way by the developers. Maybe it is difficult forthem to do, but the fact that they have ignored this is likely tolead to unfulfilled expectations at the very least. Overall, thereis obviously a far greater degree of mismatch than match ofrequirements (or at this stage understanding and perceptions)between the two parties.

The diagram is obviously only illustrative but neverthelesspowerful in its ability to convey the size of the gap. In realuse, the diagrams would have the specific elements fully definedand possibly written on the diagram in the appropriate places.However, this makes the diagrams rather messy and unwieldy soit has not been included here. When the elements of the gap arediscussed in detail and agreements thrashed out, the participantscan re-draw the diagrams with the overlap becoming larger asunderstanding develops. The point is that the diagram clearlyrepresents the current level of agreed areas of understanding andmisunderstanding between the two sides at any stage.

Beneficiary Requirements SetIn the set diagram of Figure 5, business requirements (BR)

denotes the set of all possible beneficiary requirements spacethat contains the individual (fragments) business requirementas sub-sets viewed by the customer.

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BR contains a set of individual requirements of the medicalprofession, for example, we would like to offer an e-commercefacility for our external customers (BR1), the image requiredfor this business is one of trust (BR2), the new system mustbe operational by the end of the year (BR3), the system mustbe easy for internal and external customers to use (BR4), thesystem must provide quick response for customers (BR5), thesystem must be totally secure (BR6), the system must provideenough information for beneficiaries so that they do not put anadditional burden on the existing help line (BR7), a maximumof eight people (from the business side) will be available to sup-port the development of the new system (BR8), the new systemneeds to fit very closely with the existing business processes(BR9), and the system should attract additional customers, notjust be a tailored farcicalities for existing customers (BR10).

Supplier Specifications SetAs shown in Figure 5, Supplier Specifications (SS) denotes

the set of all possible supplier specifications space that con-tains the individual (fragments) suggested specification designas sub-sets viewed by the developer.

SS contains a set of individual specification elements of thesuppliers, for example, an electronic retail channel is required(SS1), the development of the project is a major new under-taking for the ITS department (SS2), the time scale is extremelytight (SS3), the skill required are in short supply (S4), the devel-opment environment will be Unix (SS5), a mirror environmentwill be required (S6), absolute security is impossible (SS7), thedevelopment scanning images (SS8), response times depend onfactors outside of our control (SS9), and the system can uti-lize the existing processing systems for the underlying functionswhich will shortcut the development time (SS10).

The diagrams helped the parties to focus on those instancesthat were not mapped in each set. These are then reviewed, dis-cussed, and negotiated as to what they mean, why they are there,and the implications for either side. Ideally, a third stage or iter-ation of discussions is undertaken with the objective of mappingall the elements in each set.

In Figure 5, there are still a number of instances in both setsthat have not been agreed and mapped. For example, the issue of“the image of trust” is still not resolved. It might be that there isnothing on the specification side that can be done to address this.If this is the case, then this should be recorded and the require-ment instance removed from the diagram. Everybody wouldnow be clear that this is not something that the new systemcan directly deliver and there are no false expectations. Equally,there are some specification instances that are not mapped, forexample the one concerning development in Java and C++.If there is no requirement that maps directly to this, then againit should be removed. This would make it clear that there is norequirement that leads to the use of Java and C++, that someother languages could alternately be used, and that this is purelya technical decision. The customer should be made aware of the

benefits and limitations of using these development languages.In other words, dialogue and negotiation ensue. Of course, itmight be that the use of Java and C++ is in fact mapped directlyto some requirement. Either way, the developers must be veryspecific about the reasons for doing things in a particular wayand explain them to the customer so that they understand theimplications, and vice versa. As part of the process, the agree-ments are documented along with the reasoning behind thedecisions that form part of the KM exercise.

Iterations would now be entered and attempts to resolvethe mismatches made. After several iterations (depending oncomplexity of situation), there should be a greater degree ofoverlap, and in the example case there was a greater conver-gence of the requirements and specification achieved. The issueof time scale has been resolved as a result of it having been high-lighted in the first stage. The customer has understood some ofthe limitations and concerns of the developers and delayed thedeadline by two months. Thus as a result of communication, dis-cussion, negotiation, and improved understanding on both sidesthe content of the requirement changed. On the developer side,the issue of resources had been addressed, project managementaddressed, and it was agreed to buy in new skills. The sides werenow in general agreement over time scales, and response rateswere agreed. The customer agreed to match competitor systems,and the developers agreed to identify and benchmark them.Similarly, the assumptions concerning security were discussedand agreed. The customer was persuaded that total security wasunrealistic, but agreed to specific measures that reflected bestpractice in the sector and the channel.

KNOWLEDGE DIVERSITY THROUGH KSAcquisition of tacit business and TTK is very important

to any organization (Polanyi, 1967; Nonaka & Konno, 1998).Equally likely, continuous communication (Harrington, 2001;Sturt, 2000) is also vital to the progress of any organiza-tion. In most organizations, there is a clear division betweenthe providers and beneficiaries (both business users and end-users) of the proposed system and the solution providers of thesystem (i.e., different individual knowledge and perception ofknowledge; see Figures 1 and 2). Usually the developer is theinternal IT department although increasingly it is a third partyorganization, such as an outsourcing vendor or consultancycompany.

For shorthand purposes, we will refer to stakeholders of thesystem (medical personals, beneficiaries, and patients) as the“beneficiary,” and the solution providers of the system (includ-ing supplier, business analysts, systems analysts, programmers,software engineers, network specialists, security specialists),will be called “solution providers.” For convenience, we willtalk about the two sides, but this terminology should not indicatethat there is only one of each or that they are not a diverse set ofpeople and levels of seniority involved. Further, the term “ben-eficiary” is usually taken to mean the person or people (internal

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beneficiaries) within an organization who require the system tosupport their part of the business (or the business as a whole).

The specific contribution to this research study will be inthe areas of KM, SC, and the development of IS projects (Gray& Larson, 2008; Kuruppuarachchi, Mandal, & Smith, 2002;Maylor, 2004; OGC, 2005; Sieloff, 1999; Tenkasi & Boland,1996). The current concept of a system requirement is ill-suitedto develop clear “smart” requirements for large projects. Thereceived concept follows a technical rationality, which regardsrequirements as goals to be discovered and solutions as separatetechnical elements (Cavell, 1999; Regnell, Kimbler, & Wesslen,1995). In contrast, we advocate a view where a requirementspecifies a set of mappings between problem and solutionspaces, which both are socially constructed and negotiated(Figure 5).

UNDERSTANDING THROUGH KNOWLEDGETRANSFER

A major contributor to the KMS and SC operation is theproblem of understanding the beneficiaries’ requirements at theinitial requirements and identification stage of development.This section identifies and describes an approach to help over-come some of these problems, particularly the mismatch orUG between the beneficiary and the suppliers. The approach isintended to be used at the early stages of requirement determina-tion and introduces techniques from operational research (OR)into the process. In particular, set theory and Venn diagrams areused as a way of graphically representing the relationships andgaps in understanding that may exist. The benefit obtained fromthe use of the technique is partly in the graphical representa-tions themselves but mainly in the dialogue and negotiation thatresults from the construction of the diagrams (Al-Karaghouliet al., 2005). The technique has been developed in a researchstudy of retail organizations’ use of IT in the United Kingdom,and an example case study from the sector is used to illustrateand discuss the technique.

The requirements process is a sociotechnical process whichrelates to human-human interaction in the forms of commu-nication, KS, knowledge transfer, and understanding of thebeneficiary needs and the supplier (Chou & He, 2004; Hislop,2009; Jashapara, 2011); it is not a human-machine relationship.The view adopted in Knowledge Requirements Framework(KRF) (Al-Karaghouli et al., 2003) is that requirements emergefrom a process of learning (Senge, 1990; Schein, 1992) inwhich they are elicited, prioritized, negotiated, evaluated, anddocumented. Requirements evolve over time and cannot beelicited as a snapshot. This necessitates managing requirementsevolution and aligning requirements to organizational change.In any business, effective projects require detailed and spe-cific requirements which must be achieved through intensiveand rich communication between the different stakeholders(Sanghera, 1999). Unfortunately, the determination of require-ments and the development of specifications are frequently not

seen in this way but simply as something to be establishedand got out of the way as soon as possible. In many large andcomplex information technology projects, the need for a clearunderstanding of beneficiary requirements has long been under-estimated (Al-Karaghouli et al., 2003, 2005), which has led tothe failure of vital and expensive projects.

BRIDGING THE PROFESSIONAL GAP THROUGHEFFECTIVE COMMUNICATIONS

An important part of getting the requirements right is effec-tive communication and KS, knowledge transfer between thevarious groups involved in SC systems development (Hislop,2009). The process of providing a solution is conducted invarious ways in different organizations. Some adopt a veryformal approach strictly adhering to a relevant methodol-ogy, such as Structured Systems Analysis and Design Method(SSADM), whilst others adopt a softer method (e.g., SoftSystems Methodology (SSM) or Multiview). Each approachusually has some recommendation concerning the people whoshould be involved in the process at each stage. In most orga-nizations, there is still a clear division between the customersand beneficiaries (both business users and end-users) of theproposed system and the solution providers of the system.In such situations, the end or external customer is as importantas the internal customer in the determination and negotia-tion of requirements. Thus, intensive, continuous, and effectivecommunications between all beneficiaries and suppliers areextremely important to help establish a clear understanding ofthe needs which the proposed project must support in order toget things correct, first time, as much as possible.

RCKE: Identifying the KG and the UGReflecting on the RCKE illustrated in Figure 2, the bene-

ficiary’s business knowledge and acquired knowledge throughexperience is very important. On the other hand, the supplier’stechnical knowledge is also important, but the knowledge thetwo groups possess is significantly different, which leads to mis-understandings. Also, there is often a professional cultural gapwith different backgrounds, experience, management styles,and focus being evident. These “gaps” have often contributedto the failure of projects. We take a slightly broader view inthat we see the problem not only being that the suppliers oftenfail to understand the beneficiary’s business and needs, but thatthe beneficiaries in turn often do not sufficiently appreciate therealities of project development (especially ITS developments).On the one hand, we are developing methods to help identifyand make mutually apparent the gaps that exist between theunderstanding that each side in the project has, and on the otherhand, we have techniques aimed at facilitating and accelerat-ing the generation of understanding to close these gaps (seeAl-Karaghouli et al., 2003).

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CONCLUDING REMARKSThis research has shown that knowledge, KM, effective com-

munication, and SCs were identified as the most importantfactors in establishing smart and functional requirements inthe business organization with reference to the NHS in theUnited Kingdom. These factors supported the key elements ofthe theoretical framework (i.e., beneficiaries, solution providers,and commercial brokers). The results show that the theoreticalframework identifies the requirements as a sociotechnical issue.Clearly, more investigations must be carried out to ensure thatthe issues identified in this article are throughout KM and SCimplementations in project developments. Some practitionersconsider the main reason of business failure is the misuse ofITS, and others argue that the failure is because of the deficientconsideration to the culture and social issues. Some organi-zations view KMS/ITS as an obstacle to the success of theirbusiness, which could be attributed to many reasons such as tothe poor performance of an IT Department, the unclear role, andimproper use of KMS/ITS.

To summarize the arguments made so far, historical evidenceshows that exaggerated claims of the impact of technology(including e-technologies) have been made in the past fifteenyears, and the recent events of glitches and failures of manyKMS/ITS projects have revealed different outcome.

Finally, the NHS-ITS program focuses on implementationrather than the identification, elicitation, and managing require-ments. Only one in ten UK-ITS projects are delivered on time.This is due to the lack of a global quality standard that focuseson “test drive,” the track record of delivery and of outcomesof business requirements. It is worthwhile mentioning that pro-curements were unprecedented in government, they ran to ashort timescale, and we had a techie person at the other endrather than a business/procurement person. That impact hasalso been felt across the government KMS/ITS sector as awhole. Granger was one of the first of a spate of private-sectorappointees to top Whitehall IT jobs, and his stringent contractsset new standards in an environment previously dominated byprocurement fudge. There has been widespread adoption ofmore punitive penalties and rewards, but there is little evidenceof the same approachability across government KMS/ITS. Theaim of the framework shown in Figure 3 is to improve com-munications by exchanging, transferring knowledge betweenthe different parties involved to improve procurement of theright medical devices needed for daily operations, minimize thecost of distribution, and reduce time of delivery, while meetingdoctors’ and surgeons’ needs.

Research ContributionThe empirical research presented in this article investigated

the factors that influence the effective procurement process ofmedical devices. This was achieved via a critical identifica-tion and review of the knowledge and communication gapsthat exist between the medical profession and the suppliers

with regards to the procurement context. The research exam-ined the theories that have emerged from the literature reviewregarding the factors that influence the three subject areas ofKM, SC procurement process, and project management. Whilesome differences are expected, the divergence in motivationsand beliefs relative to SC management is quite stark. This sug-gests that it is not surprising that SC management are difficultto implement. For beneficiaries and suppliers to achieve a com-mon goal, a level of consensus must exist (Spekman, Salmond,& Kamauff, 1994). At the very least, beneficiaries and suppli-ers should have a shared perspective of the requirements andspecifications to form such close ties within the SC process.Thus, the challenge becomes one of forging a common view(knowledge and understanding) in which both sides can achievecompatible goals and objectives. This research hopes to help inthe implementation of SC and in particular medical managers(beneficiaries), as well as suppliers to be aware of these factors,when implementing medical devices procurement procedures.The article contributes to the area of healthcare procurement andcould be generalized to other similar area of procurements viathe developed framework (Figure 3) that bridges the knowledgeand communication gaps between both parties. The developedframework is easy, but powerful tool and straightforward toovercome such communication and understanding issues.

Research LimitationsAs with any research, this study has some limitations per-

taining to: the time constraints were the greatest limitation incollecting and analysing data.

This work presents the views of the medical professionregarding the procurements process and would have benefitedfrom the other insights of suppliers. However, this was notpossible due to the supplier unwillingness to take part in thestudy or to reveal what could be considered sensitive “marketingintelligence” in the medical device competitive market.

Another limitation is that this research used only a qualitativeapproach. Although deemed suitable for the aim of the study,it would be helpful to conduct a quantitative research study tofurther validate and enhance the framework by capturing anymissing information.

Recommendations for Future Research and ReflectionsTake into consideration the possible variation SC procedures

that are different from one company to the other and also ona county level. In addition, this study could be replicated onmore hospitals to enable a wider understanding and furthersupport the framework. Following on the limitation, a quan-titative approach with statistical analysis would enable furtherunderstanding of better understanding of the problem and pos-sible generalization of the research framework. On reflection onthis study, quantitative approaches might provide an impact ofcertain issues that qualitative approach falls short in addressing.

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AUTHOR BIOSWafi Al-Karaghouli, BA Statistics (Baghdad), MPhil Statistics

and Operations Research (London), PhD IS Failures(Brunel), MBCS, MElite. Wafi gained extensive experiencewith multinational companies. He has 12 years of industrialexperience, one of which was a Blue-chip, and 20 years ofexperience in higher education. A qualified practitioner inTQM and in Project Management Methodology PRINCE2,his interests and research revolve around IT systems failures,knowledge management, and civil aviation. Wafi has pub-lished extensively on the subject of IS failure. He contributedto the development of a Knowledge Management System atMerrill Lynch HSBC, BAA’s fast-track check-in desks andthe Iris Recognition Immigration System (iris) at HeathrowAirport.

Ahmad Ghoneim is a full time faculty member at BrunelBusiness School. He holds a PhD in Information SystemsEvaluation and an MSc in Information Systems. He pub-lished his work in well acclaimed journals such as theEuropean Journal of Operational Research as well as ininternational conferences and book chapters. He is on theeditorial team of both the TGPPP and IJEGR journals. Heco-edited special issues for journals such as the EuropeanJournal of Information Systems and the InternationalJournal of Cases in E-commerce. He is the ConferenceChair of the European and Mediterranean Conferenceon Information Systems conference. His research inter-ests include ICT adoption and investment evaluation inthe public sector, knowledge management and web2.0applications.

Amir M. Sharif is Director of MBA Programs and Professorof Operations Management within Brunel Business School,Brunel University. Amir has extensive experience in theimplementation of strategic projects across investment bank-ing, information technology, manufacturing and the publicsector. Amir has expertise in operations and supply chainmanagement, as well as information systems strategy. He hasexperience in leading management development programsat MBA and executive education levels and is the found-ing Director of the Operations and Supply Chain Systemsresearch group. Amir is also regularly invited to evaluate pro-posals for a range of national research agencies around theworld.

Yogesh K. Dwivedi is a Senior Lecturer in the School ofBusiness and Economics at Swansea University in the UK.His research focuses on the adoption and diffusion of ICT inorganizations and in addition to authoring a book and numer-ous conference papers, he has co-authored papers acceptedfor publication by journals such as CACM, ISJ, ISF, IJPR,EJIS, JORS, and JIT. He is Senior Editor of the DATA BASE,Managing Editor of JECR, and a member of the editorialboard/review board of a number of other journals, and he isalso a member of the IFIP 8 WG8.6.

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