Mitigating Barriers to Patient-centred Knowledge Sharing
A Case-study of Knowledge Sharing Problems in the Collaboration of Traditional
and Western Practitioners in Chinese Hospitals
Lihong Zhou
, Miguel Baptista Nunes
and Wenwen Liu
School of Information Management, Wuhan University, Luojia Hill, Wuhan, Hubei, 430072, China
Information School, The University of Sheffield, Regent Court, 211 Portobello, Sheffield, S1 4DP, U.K.
School of Management, Huazhong University of Science and Technology,
1037 Luoyu Road, Wuhan, Hubei, 430074, China
Keywords: Chinese Hospitals, Knowledge Sharing, Traditional Chinese Medicine, Western Medicine, Patient-centred
Abstract: This paper reports a research study that aims to mitigate and overcome barriers to the sharing of patient-
centred knowledge in the interprofessional collaboration of Traditional Chinese Medicine (TCM) and
Western Medicine (WM) professionals in Chinese hospitals. This research adopted a Grounded Theory
(GT) approach as the overarching methodology to guide the analysis of the data collected in a single case-
study design. A public hospital in central China was selected as the case-study site, at which 49 informants
were interviewed by using semi-structured and evolving interview scripts. Through the analysis of the
interview data using GT analysis methodology, 11 KS barriers emerged. With a further conceptualisation of
the KS barriers identified, it became clear that KS is mainly hindered by philosophical and professional
tensions between TCM and WM practitioners. Therefore, in order to improve KS and mitigate the two types
of interprofessional tensions, three strategies are proposed based on the findings of this study, namely: (1)
formalising KS processes and exploring effective communication channels; (2) establishing specific
interprofessional training schemes and programmes; (3) eliminating imbalances of professional power and
statues and creating conducive KS environment.
Different from any other Nation in the world, the
Chinese healthcare system uniquely incorporates
two entirely different healthcare approaches,
namely, Traditional Chinese Medicine (TCM) and
Western Medicine (WM). TCM has been a
consistent element of Chinese culture (Wong et al.,
1993) and was developed based on the result of the
accumulation of experiences and medical practices
for over 2300 years (Cheng, 2000). Hyatt (1978)
suggests that TCM is not just “folk” medicine, but a
highly developed art and science. However, TCM
lost the dominant position it had for thousands years
over the Chinese public health systems to Western
Medicine (WM) at the beginning of the twentieth
century. Modern WM, based on the scientific
paradigm and evidence-based practices, was
developed in Europe and North America after the
industry revolution and is largely considered as the
main component of today’s Chinese medical system,
despite its coexistence with TCM (Chi, 1994).
The coexistence of the two healthcare
philosophies and professional communities were
initially formulated under a political decision made
by Chairman Mao Zedong in early 1950s,
immediately after the establishment of the People’s
Republic of China (PRC). The original purpose of
the political decision was to use a reformulated and
systematised TCM as a strategic tool to distinguish
the new communist China from its superstitious and
feudal past as well as to illustrate the Chinese
cultural heritage. Despite the political nature of the
decision, many researchers (e.g. (Fruehauf, 1999);
(Taylor, 2004); (Hyatt, 1978)) have claimed that it
created conditions for a complementary relationship
with WM. This relationship was unexpectedly very
successful, since it unites and synergises the two
types of professionals working cooperatively against
a number of diseases deemed to be untreatable
Zhou L., Baptista Nunes M. and Liu W..
Mitigating Barriers to Patient-centred Knowledge Sharing - A Case-study of Knowledge Sharing Problems in the Collaboration of Traditional and Western
Practitioners in Chinese Hospitals.
DOI: 10.5220/0004546002980307
In Proceedings of the International Conference on Knowledge Discovery and Information Retrieval and the International Conference on Knowledge
Management and Information Sharing (KMIS-2013), pages 298-307
ISBN: 978-989-8565-75-4
2013 SCITEPRESS (Science and Technology Publications, Lda.)
solely by WM doctors (Taylor, 2004). The
interprofessional collaboration of TCM and WM
healthcare professionals gradually emerged as the
central basis to the provision of healthcare services
in today’s Chinese hospitals.
However, the two professional communities, that
sometimes operate in the same building, do not
really co-exist harmoniously in the national
healthcare system (Liu, 2003). This co-existance
arose from the initial political decision, but it
became very quickly apparent that simply putting
the two communities together and expect them to
work collaboratively was not without problems. In
fact, each community have integral and very
distinctive medical beliefs, diagnose and treatment
methodologies. This careless integration of the two
generated disbeliefs, distrust and disregard between
the two communities and resulted in the problems of
coexistence in Chinese hospitals today (Liu, 2003).
In any case, regardless of any disagreements, dispute
and problems of co-existence, it is politically
decided that the two communities have to
Since 2006, with the implementation of the
patient-centred healthcare policy, an additional layer
of political requirements was forced upon the TCM
and WM collaboration. That is, the needs,
requirements and benefits of patients must be
constantly ensured and carefully protected
throughout the processes of TCM and WM
collaboration (Zhong, 2009); (Hu, 2009).
The provision of patient-centred healthcare
service relies on effective and sufficient
communication and knowledge sharing (KS)
(Steward, 2001); (Maizes et al., 2009). Nonetheless,
and in reality, TCM and WM professionals do not
necessarily actively and voluntarily communicate
and share knowledge with each other (Zhou et al.,
2010); (Liu, 2003). In fact, there are barriers
hindering the two types of professionals from
actively engaging in KS (Sun, 2003); (Liu, 2003);
(Zhou and Nunes, 2012).
Despite public awareness of the issues that
emerged from the TCM and WM coexistence and a
continuing debate on philosophical superiority, the
KS problem between TCM and WM professionals
has not been politically recognised and academically
investigated. This paper presents, criticises and
discusses the barriers to patient-centred KS between
TCM and WM professionals. In addition, this paper
proposes and discusses actionable strategies that can
be employed by hospital management to improve
interprofessional communication and KS in TCM
and WM collaboration.
2.1 Duality and Complementarity of
TCM and WM
Through several decades of exploration and
negotiation, TCM and WM practitioners in Chinese
hospitals have gradually accumulated and formed
complementary relationships. In order to thoroughly
explain the complementary relationships, it is
necessary to understand the basic beliefs, base
philosophies, and diagnosis and treatment methods
of the two types of medicine.
TCM emphasizes on the integrity of the human
body as whole and its close relationship with the
environment (Cheng, 2000). According to the study
of Ma (1999), traditional Chinese healing practice is
intended to enhance the immune system of human
body, antiviral effects, anti-inflammation, balance of
mind and body, aches and pain relief, and
cholesterol reduction. There are four main categories
of Chinese medicine treatments, namely herbal
medicine (oral intake and external use), heat therapy
(moxibustion and cupping), massage (oriental
massage, Gua Sha and magnets) and acupuncture
(Sherman et al., 2005).
Conversely, WM employs a scientific attitude in
treating patient problems (Dally, 2003). Unshuld
(1985) claims that achievements from intensive and
evidence-based fundamental scientific research have
brought WM to an unchallengeable dominant
position in world health care as well as in China. In
fact, and despite the plurality, in the Chinese
healthcare system WM takes the primary position
being complemented by TCM as an alternative
healthcare therapy. It is widely accepted in China
that WM is more effective in the acute stage of
many diseases and works much faster than TCM in
treating these acute diseases (Ma, 1999). However, it
is also acknowledged that WM creates more adverse
side effects (Kaptchuk, 2000). Nevertheless, healing
herbs, acupuncture, massage and other health
methods from TCM may be more appropriate in
health promotion, prevention, treatment, and
rehabilitation. Moreover, TCM may be used as a last
resort, when Western medicine is either too toxic or
unable to provide any further expected benefit (Chen,
The main difference of Chinese traditional
medicine in relation to its Western counterpart is its
adoption of a holistic concept of healing, which
emphasises the integrity of the human body as a
whole and its close relationship with the
environment (Cheng, 2000). In contrast, WM
doctors are more interested in localised diseases or
illnesses and the corresponding part of the human
body. WM practitioners aim at healing that specific
part of the human body rather the more general
problems of the patients (Dally, 2003).
Moreover, TCM and WM have entirely different
conceptual systems. For TCM doctors, the Yin-Yang
theory is an ancient Chinese belief and way of
understanding the universe and is the most essential
theoretical foundation to the practice of TCM
(Cheng, 2000). In contrast to TCM, which is based
on Chinese ancient beliefs, WM is based on
scientific paradigms and evidence-based research
(Zhou and Nunes, 2012) and is a combination of
modern science and the art of healing (Warrell et al.,
Furthermore, the two types of healthcare
methodology have completely different diagnosis
methods. TCM doctors follow the ancient theory of
Bian-zheng (distinguishing patterns) (Cheng, 2000),
which can be generally defined as “the process of
identifying the basic disharmony that underlies all
clinical manifestation” (Maciocia, 1989: 175). To
support the processes of Bian-zheng, TCM doctors
apply four diagnosis methods to patients, namely
“inspection”, “listening and smelling”, “inquiry” and
“palpation” (Wang et al., 2004). Liu (2003) further
points out that the TCM diagnosis mainly relies on
the doctors’ professional experiences and personal
understandings of Bian-zheng. In this case, it is very
common for different TCM doctors to produce
totally different diagnoses of the same patient (Liu,
2003). In contrast, WM professionals investigate the
problems of patients and make decisions based on
the identification of accurate medical evidence and
the employment of modern diagnostic technologies,
such as x-rays, laboratory tests, and computed
tomography (CT) (Fitzgerald, 1990).
Finally, TCM and WM professionals have very
different treatment approaches to dealing with
patient problems. In the TCM methodology, there
are four main categories of treatments: herbal
medicine (oral intake and external use); heat therapy
(moxibustion and cupping); massage (oriental
massage, Gua Sha and magnets); and acupuncture
(Sherman et al., 2005). These methods used by TCM
doctors are often considered as too unusual by those
WM healthcare professionals who are following the
doctrine of modern medical science. To them,
patient treatments can be simply divided into two
categories, namely: medication and surgery
(Goldman and Ausiello, 2008).
Liu (2003) asserts that WM is a hard science,
whereas TCM is an empirical [soft] science. Even
though the two approaches are entirely different, the
integration of the two healing beliefs into the
Chinese healthcare system constitutes a unique
therapeutic plurality, which is believed to be
beneficial to patients, and which is only presented in
the structure of the Chinese healthcare system.
The advantages and benefits of integrating TCM
and WM services into a single healthcare system, as
well as the implementation of complementary
treatment have become evident. In any case, the
complementarity and collaboration of the two types
of healthcare professionals should be based on the
communication and sharing of technical and patient
knowledge with each other.
2.2 Patient-centred Knowledge Sharing
KS can be simply understood as the behaviour of
making knowledge available to others (Ipe, 2003). In
the healthcare environment, KS is defined as follows:
“Healthcare knowledge sharing can be characterised as
the explication and dissemination of context-sensitive
healthcare knowledge by and for healthcare stakeholders
through a collaborative communication medium in order
to advance the knowledge quotient of the participating
healthcare stakeholders.” (Abidi, 2007: 69)
According to this definition, and considering the
patient-centred TCM and WM collaboration,
healthcare professionals need to share the following
three types of patient knowledge:
Technical Knowledge includes identification of
patient conditions and problems, reasons and
objectives of patient care, patient background,
agreement to treatment strategy, and explicit
patient requirements and needs (Smith, 1996).
Ethical and Emotional Knowledge is about
ethically dealing with patient feelings, emotions,
and psychological status; approaches to
communicating with, persuading and managing
individual patients; and maintaining trusting and
collaborative professional-patient relationships
(Fennessy and Burstein, 2007).
Social and Behavioural Knowledge is concerned
with anticipating how others will behave,
perception of patients’ implicit requirements,
behaviours and reactions, and expectations
(Fennessy and Burstein, 2007).
Among the three types of patient knowledge, the
sharing of technical knowledge is the least
problematic, since technical knowledge is easier to
share and is usually recorded explicitly in the patient
records. Moreover, the two types of healthcare
professionals have adopted two entirely different
therapeutic systems and each other’s philosophical
beliefs and technical insights do not seem to matter
in the complementary provision of medical service
(Guo, 2006); (Yang, 2005). On the other hand, the
ethical and emotional knowledge and the social and
behavioural knowledge consist of experiences and
perceptions of individual professionals, which are
accumulated through processes of dealing and
interacting with individual patients. Therefore, when
compared with the technical knowledge, these two
types of tacit patient knowledge are more difficult
and more important to share among healthcare
professionals. Thus, this study focuses on these two
types of tacit patient knowledge.
3.1 Research Questions
According to the main aim of this study, which is to
identify barriers to sharing patient knowledge in
TCM and WM collaboration, the following research
question was formulated:
What are the barriers to sharing patient knowledge
between healthcare professionals from Traditional and
Western medicine in their patient-centred
interprofessional collaborations?
In the light of the main research question, three
specific research questions were established:
What are the barriers that hinder the sharing of
patient knowledge between TCM and WM
healthcare professionals?
What are the relationships between these barriers?
What practical strategies can be formulated in
order to improve KS?
The research questions were adopted to point a
direction to the selection of research methodology,
the research design as well as the collection and
analysis of data.
3.2 Research Approach and Design
Since there are virtually no empirical studies that
have been performed on the communication
problems between TCM and WM professionals in
Chinese hospitals, this study adopted an inductive
approach and aimed at developing a new and
contextualised theory. Therefore, a Straussian
Grounded Theory (GT) was selected as the main
research methodology, since GT is widely
recognised as particularly useful for theory
generation and development (Strauss and Corbin,
1998). In addition, in order to allow a theory to
emerge from a suitable research context, GT was
applied in a social context provided by case-study.
Moreover, considering China is one of the largest
countries in the world, with a population exceeding
1.3 billion and with 56 ethnic groups and 34
provinces, it would be virtually impossible to
generate a theory that would encompass the whole
nation. Consequently, and since this project aimed at
generating a first set of insights into this problem, a
single case-study design was adopted. A public
hospital in the city now city of Xiangyang (Xiangfan
at the time of data collection), province of Hubei,
was selected for the case-study. This hospital was
chosen for two main reasons. Firstly, it provides
both WM and TCM services to patients and has
done so for several decades. Secondly, the
researcher obtained guaranteed and management
supported access to the informants and the project.
Furthermore, during the processes of data
collection and analysis, it was observed that
different departments in the hospital exhibited very
different levels of integration of complementary
treatments. This study therefore focuses on one
specific department, namely the Department of
Neurosurgery. This department has a proven history
of using WM and TCM compound treatments for
rehabilitating patients after craniotomies.
Semi-structured interviews were adopted as the
data collection tool. Moreover, as required by the
GT theoretical sampling strategy, interview
participants were sampled by the emerging theory
and interviewed using evolving interview question
scripts. Overall, 46 informants were interviewed in a
total number of 49 interviews. These informants
were 27 healthcare professionals, 7 TCM
professionals, 1 chief hospital manager, 1 hospital
ICT manager, 1 TCM professor at local university, 1
healthcare politician in local government, and 8
patient relatives and carers.
As required by GT, the processes of data
collection and analysis were operationalised
interactively. That is, immediately after each
individual interview, the collected data were
transcribed and analysed. The analysis of data
collected adopted two essential GT analytical tools,
namely, coding (open, axial and selective) and
constant comparative analysis. Consequently, data
collection and analysis coexisted until the theoretical
saturation was achieved, that is, until no new open
codes emerged from the data analysis. The final
theory saturated with 11 KS barriers.
4.1 Process of Sharing Patient
Through the processes of data analysis, it became
clear that the interprofessional collaboration of TCM
and WM professionals is considered as fundamental
to the treatment of neurosurgical patients, since
“more than half of our [neurosurgical] patients are
using TCM treatments” (Interview WMD 2.72). As
described by the interview informants, when dealing
with patient problems, WM is employed as the
primary methodology and was always used in the
first instance. TCM methods are implemented as a
complementary approach and are usually considered
as more effective at the post-craniotomy and
rehabilitation stages.
“Patient usually has some problems after the brain
surgeries. These problems may lead to some serious
sequelae. For these problems, patients can use TCM
herbal medicine and acupuncture to assist rehabilitation
after surgeries. TCM is not usually used before
surgeries.” Interview WMD 20.15
Interprofessional collaboration and KS usually occur
in consultation sessions, which are usually requested
by a neurosurgeon, when a patient condition is
perceived to be better treated by TCM doctors. The
nurse in charge usually initiates the process at the
request of the neurosurgeon and contacts the TCM
doctors directly to make an informal enquiry. If the
TCM doctor agrees his/her commitment, the
neurosurgeon initiates a consultation note as a
formal invitation for collaboration. The consultation
note records a very brief description of all
procedures and medical decisions that are made
during the consultation session. After this
consultation session, WM and TCM professionals
never meet again to discuss that particular patient,
unless in the case of emergencies. The consultation
note must be signed by doctors from both sides and
documented in the patient records.
As perceived, these consultation sessions could
be a relatively good communication channel for KS,
since they require the presence of professionals from
both teams and to work collaboratively and
interactively on specific health problems of a
specific patient. However, the data collected reflect
that these meetings in reality cannot be considered
as a good communication channel and is fraught
with barriers that hinder interprofessional
communication and the sharing of patient
4.2 KS Barriers
Through the data analysis, two categories of KS
barriers were emerged, namely, philosophical
barriers and professional barriers.
4.2.1 Philosophical Barriers
The data collected show that WM and TCM have
completely different conceptual, philosophical and
methodological systems. These fundamental
differences in the philosophical roots of the two
types of medicines have resulted in significant
barriers to the sharing of patient knowledge.
Specifically, five barriers emerged and were
identified in the data analysis as follows:
1. Different Conceptual Systems: The KS problems
between TCM and WM professionals are rooted in
the basic concepts and beliefs of the two types of
medicines. The data analysis revealed that, apart
from a unified purpose to resolve patients’ problem,
the provision of TCM and WM services are based on
two entirely divergent systems, including differences
in philosophical views, theoretical foundations,
treatment and diagnostic approaches. This finding
confirms that findings of the literature review.
“They [TCM doctors] have a totally different theoretical
system, which we [WM professionals] do not understand.
[…] Undeniably, there are a number of conflicts between
the two theoretical systems, but their [TCM] methods are
effective. Nevertheless, WM is probably more effective
and as a WM doctor, I believe in our system. They
believe in theirs. There are clear conflicts.” Interview
WMD 9.25
These conceptual differences could cause conflicts
of understandings of patient problems and
requirements, and result in conflicts in actions aimed
at solving patient problems and achieving patient
requirements. These conflicts could hinder processes
of interprofessional communication and prevent
activities of sharing patient knowledge.
2. Different terminology systems: Upon the
completely divergent conceptual and methodological
systems, TCM and WM healthcare professionals
have entirely different systems of terminology and
use very different professional terms and jargon to
describe and explain patient problems and
“[WM and TCM] have two terminological systems.
Maybe both of them have an identical purpose, but how
they express the purpose is entirely different.” TCM
Differences in terminology make KS particularly
difficult, since TCM and WM professionals cannot
understand each other’s language. Patient
knowledge shared by one side probably cannot be
correctly received and fully comprehended by the
other side. Therefore, the terminology difference is a
KS barrier.
3. Conflicts of Philosophical Beliefs: During the
interviews, TCM and WM healthcare professionals
showed a consistent lack of belief in each other’s
practices. Many interviewed WM professionals not
only expressed that WM is “purely scientific and
superior to TCM” (Interview WMN 14.15), but also
showed strong disbelief, distrust, disagreement and
even discrimination against TCM. In fact, TCM
philosophy and methodology was often harshly
criticised as “unscientific” (Interview WMD 1.64)
and useless “superstition” (Interview WMN 14.17).
On the other side, TCM doctors strongly disagree
that TCM is considered as inferior to WM. Many
TCM doctors defended their methodology is a “solid
medical methodology” (Interview TCM 4.9), which
consists of a systematic and consistent set of
diagnostic and treatment methods and which has
been accumulating and revising through an
evolution of thousands of years. Moreover, many
TCM interviewees disagree with some of the WM
beliefs and methods, which they asserted are not
always appropriate and which sometimes have
adverse effects on patients’ conditions.
Evidently, the philosophical conflicts augments
conflicts of opinions and perspectives of the two
types of professionals, and have created a climate of
distrust, disregard, and unwillingness to
communicate in the two communities.
4. Inadequate Interprofessional Common Ground:
The data analysis identified a lack of
interprofessional common ground, which can be
theorised as a knowledge base of overlapping
interests and shared conceptual understandings. The
research findings show that the lack of
interprofessional common ground could result in
philosophical conflicts and disagreements with each
other’s views and opinions, enhance untrusting
relationships between the two medical communities,
and thus is identified as a KS barrier.
“Communication, if without a knowledge basis, is
impossible. For me, I can easily communicate with WM
doctors, because I nearly learnt all WM knowledge. But
if WM doctors do not learn TCM, they will never accept
our philosophy.” Interview TCM 6.72
5. Insufficient Interprofessional Education and
Training: The inadequacy in interprofessional
common ground, as indicated in the research
findings, is probably resulted by a lack of
interprofessional education in Chinese healthcare
HE. Specifically, the healthcare HE structure in
China consists of TCM education and WM
education, as two almost entirely isolated systems
with very limited programmes, courses and modules
designed and included focusing on the convergent
areas of TCM and WM.
“We [WM professionals] only have a very basic
understanding about TCM, actually very superficial. We
only learnt something like the palpation, nothing else.
Almost nothing learnt in medical school” Interview
WMN 14.29
Moreover, the data analysis identified an absence of
focus and exercises on hospital interprofessional
training on the areas of convergence aiming at
establishing mutual understandings between the two
professional communities. Consequently, it is
evident that, due to the insufficient interprofessional
education and training, TCM and WM practitioners
do not have a sufficient common ground to facilitate
necessary interprofessional communication and KS.
4.2.2 Professional Barriers
Apart from the KS barriers emerged from the
substantial divergences of TCM and WM
philosophy, some professional issues were emerged
as barriers to interprofessional KS. Specifically, the
data analysis identified six professional barriers.
1. Asymmetrical Decisional Power: The data
collected exhibit evidences of substantial
asymmetries of positional power and professional
standing of the two medical communities.
“If neurosurgical patients need acupuncture treatments,
neurosurgeons would initiate a consultation note and
telephone us. Then we go to treat patient with
acupuncture. […] In this process, we do not have
decision power. For example, this patient clearly needs
TCM treatment, but we cannot do anything about it,
because neurosurgeons need to make this decision, not
us.” Interview TCM 16.17
As shown in data, for instance the quotation above,
when collaborating with TCM doctors, WM
practitioners have a relatively higher professional
standing and almost complete control over patients.
Comparably, TCM doctors possess a relatively
lower professional standing and hold less power.
Therefore, TCM doctors are most likely to maintain
a passive position, avoid any confrontations and to
follow instructions, instead of actively and
voluntarily proposing their ideas, opinions and
suggestions. For them, even if they intend to share
knowledge, they have very little power or influence
to have their views recognised. Therefore, it is a
significant KS barrier need to be carefully resolved.
2. Overwhelmingly High Workload: As both
witnessed in the field and reflected in data, both
types of practitioners were extremely busy and had
very high workloads. A number of interviewees,
therefore, informed that they are more concerned
with “take care of patient [solving patient’s
immediate problems]” (Interview TCM 15.45),
rather than contributing time in interprofessional
communication and KS. This also emerged as a KS
barrier, since processes of sharing patient knowledge
could be largely neglected.
“[In the consultation] usually they do not ask many
questions, and we do not talk that much. We all are very
busy. As long as we can treat the patient, that is all right.
We all are too busy to actually sit down and to have a
deep conversation.” Interview TCM 37.63
3. Rigid Problem-oriented Collaboration Approach:
As identified in the data analysis, the sharing of
patient knowledge is constrained and hindered by
the adoption of an overly rigid problem-oriented
approach to collaboration. In this approach, as long
as those patient problems can be resolved,
interprofessional communication and KS would be
considered as not really important and as something
that can probably be ignored, for instance a TCM
and a WM informant stated that:
“(In WM and TCM collaboration) we do not need to
know TCM theory and method. We just want them
(TCM doctors) to help us to solve patients’ problems.”
Interview WMD 48.12
“The reason why neurosurgeons invite us to join a
consultation is that they want us to solve their problems.
I don’t think they are trying to understand TCM or how
we think of the patient.” Interview TCM 4.81
Evidently, this approach to collaboration is not an
encouraging mechanism for sharing any form of
4. Inefficient Communication Channels: As
discussed in section 4.1, KS occur in consultation
sessions, which could be perceived as useful vehicle
for exchanging patient knowledge. However, as a
communication channel, these meetings can only
play a very limited role in real KS between the two
professional groups. In reality, as expressed by a
number of informants, the meetings last usually “no
more than 10 or 20 minutes” (Interview WMN
7.119), in which “the diagnosis of the patient is
presented by a WM doctor and then usually we [the
visiting TCM doctor and the neurosurgeon in charge]
need to have a brief discussion” (Interview TCM
4.92). This is of course not conducive to in-depth
interprofessional discussions. Thus, the consultation
meeting in fact becomes a formal handover of
patients and not a vehicle for the exchange of patient
5. Absence of Explicit KS Requirements from
Hospital Management: As shown in the data
collected, even though the hospital management has
been repetitively emphasised on integrating KS
concepts and practices into the provision of
healthcare services, “no specific requirements or
guidelines have been formulated which explicitly
demand interprofessional communication and KS”
(Interview WMD 20.13). Therefore, professionals
from both medical teams probably perceive that
communication and KS are optional, not compulsory,
and not important.
“If there are have some kind of regulations that WM and
TCM teams need to adequately communicate and KS,
practitioners are forced to do this. But, we do not have
these requirement. It is like if you [a WM practitioner]
do not talk with TCM doctors for ten years, no one
would care about that and no one would criticise you.
There is no supervision.” Interview WMD 1.83
6. Imbalanced Management Support: As reflected
in the data, the hospital management provides more
attention and support to WM departments, whereas
the TCM department is not only less supported, but
also could be discriminated by the hospital
management and viewed as “secondary in the
hospital” (Interview WMD 23.17). There are two
reasons as point out in the data analysis: firstly,
nearly all power figures in the hospital management
team have WM backgrounds and hence would attach
more attention and support on WM departments;
secondly, and more critically, WM departments are
much more financially profitable when compared
with the TCM department. It is important to note
that financial profitability became particularly
important to the survival of hospitals in China after
the implementation of Market Economy Policy,
which determined that all hospitals are themselves
responsible for all hospital operation expenses.
The imbalanced hospital support has exacerbated
the already existing philosophical conflicts,
encouraged interprofessional competition,
augmented imbalances of power and distanced
professional standings. Thus, professionals from
both communities are not motivated and even
unwilling to communicate and share knowledge with
each other.
With further distillation and conceptualisation of the
findings, it became clear that the identified KS
barriers have resulted in two types of
interprofessional tensions, namely philosophical
Figure 1: Philosophical and Professional Tensions as Main Barriers to KS between TCM and WM practitioners.
tensions, and professional tensions, which then
emerged as the centres of the KS problems between
TCM and WM practitioners.
Philosophical tensions are caused by the
substantial divergence in philosophies,
theoretical grounds and conceptual systems of
TCM and WM. These tensions have resulted in
conflicts of opinions and perspectives, which in
turn have created a climate of distrust, disregard,
and unwillingness to communicate in the two
communities. Additionally, the philosophical
tensions are resulted by a lack of
interprofessional common ground to facilitate
communication and KS. The lack of
interprofessional common ground is caused by
lacking of interprofessional education in the
Chinese healthcare education and by lacking of
interprofessional training in the hospital
Professional tensions result from the substantial
asymmetries of power and professional standings
between the two medical communities. The data
analysis clearly revealed that neurosurgeons have
relatively higher professional standings and have
almost dominant power over patients. Therefore,
they often explicitly instruct and regulate TCM
doctors on what to do with the patient.
Comparably, TCM doctors have lower
professional standings and hold relatively less
power. Therefore, TCM doctors are most likely
to maintain a passive position when collaborating
with neurosurgical practitioners, avoid any
confrontations and to follow instructions, instead
of actively and voluntarily proposing their ideas,
understandings and suggestions.
Moreover, the conceptualisation of the research
findings included an analysis of the cause-
consequence relationships between individual
barriers. The result of the analysis can be illustrated
in a concept map as shown in Figure 1. As shown in
Figure 1, KS barriers are causes to philosophical
tensions and professional tensions as two conceptual
centres of the emergent theory. Furthermore, both
types of tensions are interrelated and reinforce each
other. Hence, to improve KS and communication
between TCM and WM practitioners, efforts need to
be put on mitigating and resolving the two types of
interprofessional tensions. More specifically, to
effectively resolve the two tension, it is necessary to
examine individual KS barriers and establishing
actionable strategies to mitigate the effect of each
In addition, as shown in Figure 1, three KS
barriers are marked with “*”, namely, inadequate
interprofessional common ground, imbalanced
management support, and absence of explicit
requirement from hospital management. These
barriers are interlinked with others as either causes,
or consequences. In this case, strategies should be
developed targeting at these barriers. As reflected
from the research findings, the following three
strategies should be adopted and implemented by the
hospital management:
1. To develop and reinforce the interprofessional
common ground, the hospital management
should establish very specific interprofessional
training schemes and programmes. For both
types of healthcare professionals, these
programmes and sessions could increase mutual
understanding, acceptance of each other’s
philosophy and beliefs, could enhance a better
understanding of each other’s professional
terminology and, more importantly, effectively
put in place an common ground to enable,
facilitate and motivate interprofessional
communication and KS.
2. In order to relieve the professional tensions,
explicit management strategies should be
formulated and implemented aiming at equally
supporting TCM and WM communities,
eliminate imbalances of power and professional
standings and foster a harmonious hospital
environment, which could be more conducive for
interprofessional collaboration and
3. It is necessary to formalise the process of
interprofessional collaboration and formally
define activities and processes of sharing patient
knowledge. Moreover, there is a need to explore
new communication channels and tools to
facilitate the process of sharing patient
knowledge, for instance and as reflected in data,
patient records and consultation notes could be
much better used and explored. Finally, as also
identified during the process of data collection in
the field, the hospital was under the processes of
designing and implementing a new Information
System. Therefore, there is the opportunity to
create new communication platforms that can be
developed within the hospital intranet and
support better communication and KS.
Finally, it needs to be highlighted that these
strategies must be fully supported by hospital
managers and leaders in both medical communities,
who should realise that the collaboration of TCM
and WM is not just a political imperative, but may
bring tangible benefits to patient welfare, through
mutual trust between these complimentary medical
This paper is supported by the National Natural
Science Foundation of China (Project No. 71203165)
and the Wuhan University Research Grant (Project
No. 2012GSP076).
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