EXTERNALIZATION METHOD AND ITS EVALUATION
OF KNOW-HOW INFORMATION FOR CARE PLANNING
PROCESSES BY AWARENESS OF NOVICES
Kaoru Eto, Minoru Mukuda and Yasuo Kabasawa
Faculty of Engineering, Nippon Institute of Technology , 4-1 Gakuendai, Miyashiro, Minamisaitama, Saitama, Japan
Tatsunori Matsui
Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima Tokorozawa, Saitama, Japan
Keywords: Know-how information, Method externalization, Care planning processes, Tacit knowledge, Awareness of
novices.
Abstract: The know-how information to perceive care needs based on assessment results is crucial to improve the
quality of care service. We developed a know-how information sharing system for care planning processes.
We propose a method that externalizes and shares know-how information by visualizing and observing care
plans drawn by experts in various forms that allow beginners to notice the differences between the plans of
novices and experts. Sharing know-how information is possible by recording, accumulating, and referring to
what has been observed when comparing documents. This system two-dimensionally maps and visualizes
each document based on the differences among documents perceived by the assessment results.
Externalizing and sharing know-how information are supported by visualization. Trial results in a care
facility confirmed that our system effectively externalized and shared know-how information. Improvement
in individual capabilities, organization growth, and the possibility of rejuvenation were confirmed by using
our system.
1 INTRODUCTION
The acquisition of capabilities to perceive care needs
based on assessment results is crucial to improve the
quality of care service. However, based on advanced
cognitive power and judgment, insight, and a
discerning eye, know-how information is needed for
perception. Therefore, it is difficult for beginners to
exactly perceive care needs. To solve this problem,
we propose a method that externalizes and shares
know-how information for care planning processes
by awareness of novices.
In recent years in business administration, much
attention has been paid to the role knowledge
management plays in company strategies. Many
studies have investigated methods to externalize and
share tacit knowledge (
Choudrie, 2005). Know-how
information has mainly been studied as part of
knowledge management. Research on knowledge
management has also been conducted in the medical
treatment and nursing fields (Abidi
, Cheah, and
Curran, 2005)
. These researches emphasized the
externalization and the sharing of the know-how
information possessed by experts themselves using
information and communications technology (ICT).
However, directly treating know-how information is
difficult because the information about which an
expert is not conscious can’t be externalized.
Moreover, since the externalized know-how
information includes many premises, such as the
situation of the scene and its context, it has
intentional disagreement between the provider and
the user of the know-how information. The problem
of burying useful know-how information, sharing,
and transfer is also difficult.
Therefore, an approach
is needed that complements sender intentions about
the information and establishes an implicit premise.
In this study, we propose a method that
visualizes and observes care plans drawn up by
experts in various forms that allow beginners to
notice the differences between the plans of novices
201
Eto K., Mukuda M., Kabasawa Y. and Matsui T..
EXTERNALIZATION METHOD AND ITS EVALUATION OF KNOW-HOW INFORMATION FOR CARE PLANNING PROCESSES BY AWARENESS OF
NOVICES .
DOI: 10.5220/0003090502010206
In Proceedings of the International Conference on Knowledge Management and Information Sharing (KMIS-2010), pages 201-206
ISBN: 978-989-8425-30-0
Copyright
c
 2010 SCITEPRESS (Science and Technology Publications, Lda.)

and experts.
With the proposed method, we expect
that the knowledge to be acquired about which
experts are not conscious as well as the knowledge
required for an on-site level for beginners who will
notice the differences between novices and the
skillful.
Moreover, since beginning users of the
information noticed the know-how information,
which is named in their own words, such transfer of
preconditions as a scene’s situation and its context
are carried out smoothly; sharing and internalizing
know-how information is performed easily and is
considered a connection to the practical use of
knowledge.
Furthermore, when a beginner repeats
and uses this system, an important education effect
is acquired in the process of sharing, based on
externalizing the know-how information.
Internalization, socialization, and individual
capability improve to attain organization growth and
rejuvenation. Based on such an idea, we developed a
know-how information sharing scheme called KISS.
In this paper, we clarify its effectiveness from the
results of a two-year trial experiment in a care
facility.
2 EXTERNALIZATION OF
KNOW-HOW INFORMATION
Our concrete method of externalizing know-how
information by allowing beginners to notice the
difference from experts is shown in Figure 1. Tacit
knowledge is used when experts assess clients and
compile charts from which they perceive care needs.
Therefore, the following questions have such
explicit knowledge as theories and rules and such
tacit knowledge as original viewpoints, original
patterns, and conceptualization based on experience:
How is this life changing? What are the harmful
factors for it? What are its remaining abilities? What
are its basic care guidelines? On the other hand, the
externalization of tacit knowledge is fueled by
metaphor and/or analogy (Nonaka and Takeuchi,
1995). Association through analogy is carried out
by rational thinking and focuses on the
structural/functional similarities between two things
to detect differences (Nonaka and Takeuchi, 1995).
We adopted a method of enabling the externalization
of know-how information by supporting the
cognitive process of analogy. The function is
explained below that supports the four steps of the
cognitive process of analogy:
(1) Retrieval: past similar experiences recollected
from memory. A beginner observes charts that
reflect the assessments drawn up by experts and
reads their contents.
(2) Mapping: both features and structure are
connected to past similar experiences and matched
with a target’s knowledge: The chart group, which
visualized the assessment result, is observed to grasp
that the relevant viewpoint has been narrowed down
and expanded.
(3) Evaluation: analogy appropriateness evaluated
with reference not only to the external similarity but
also structural similarities and targets. The two-
dimensional mapping result is observed of the
perceived document group that visualized the
difference between the perceiving documents as a
result of assessment.
(4) Learning: experience that solved the target using
past similar experience is accumulated as abstract
knowledge through induction and abstraction of the
relations, common patterns, rules, etc.
A beginner's perceiving document is mapped and
visualized on the same two-dimensional plane as the
experts’ perceiving documents so that the beginner
can observe them. There is an effect that easily
extracts patterns in the visualization of information.
A beginner records what has been noticed by
comparing charts as the results of assessment and
two-dimensional mapping of the perceiving
document group.
Thus, beginners gradually notice the differences
between experts and novices by repeating the
cognitive process of analogy. This awareness
becomes a trigger that will separate explicit and tacit
knowledge. Know-how information is included in
this awareness. Externalizing and sharing know-how
information are realized because a beginner records
and refers to awareness. Moreover, the charts, which
are one source of information media in the process
that externalizes tacit knowledge to enable beginners
to assess a client's condition and perceive care needs
based on results, play an intermediate role of tacit
and explicit knowledge.
3 USE OF SYSTEM
As examples of system use, mapping into two-
dimensions added new cases, and displaying of
charts and
the search results of documents by user
name are shown.
3.2.1 Mapping Several users' Perceiving
Documents on Two-dimension
Nurses and care workers assess a patient/client and
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Figure 1: Externalization of tacit knowledge.
separately draw up a care plan and discuss it. The
similarity of their documents can be simultaneously
displayed in two dimensions. Noticing differences is
promoted by exhaustively comparing these results.
This function shows different viewpoints of co-
workers, different occupational descriptions, and
shared information. Furthermore, the “Ba (field),”
which is the context shared by co-workers who
mutually conduct interactions, is offered. The
mapping result of new cases at the same plane as the
model cases is shown in Figure 2. The number
beside the round mark is a case number. The state of
106 examples is expressed as four colors. The stars
are new cases. In Figure 2, arrows indicate whether
the mapping of a user’s case is appropriate (Eto,
Matsui, and Kabasawa, 2006). On this screen, four
persons’ documents are in different positions. The
KOMI Chart is compared to explore why they differ.
3.2.2 Referring to Awareness Document
Users can search for documents by keyword and
user name. When a keyword is input, the list of
document file names is displayed, so a file name can
be chosen. A document can also be referred to by
user name search (Figure 3). Since the time at which
it was written is part of the file name, the user’s
awareness document history can be followed by a
time series.
4 SYSTEM EVALUATION
One target of this study is the development of a
system that can actually be used at care facilities.
Therefore, an important element of system
evaluation is how many care facility requests are
reflected.
Figure 2: Two-dimensional map to add new cases and
display new charts.
Figure 3: Document search result.
Assessment Results (Charts)
Assessment
Perceive
d
Results
Perceive
d
Results
Client
intermediate language
explicit
Tacit Knowledge
Visualization
Metaphor and Analogy
Explicit＋Tacit knowledge
Perceiving factors
(1) How is this life changing
(2) Harmful factors
(3) Remaining abilities
(4) Basic care guidelines
Explicit Knowledge
Two-dimensional mapping
of perceiving documents
Comparison
Awareness
explicit
Visualization
Changing
Viewpoint
Recording
Tacit Knowledge (Know-how)
☆
☆
☆
☆
N
ew Cases
User I
User H
N
oticed
d
ocuments
List of noticed documents
User name list
EXTERNALIZATION METHOD AND ITS EVALUATION OF KNOW-HOW INFORMATION FOR CARE
PLANNING PROCESSES BY AWARENESS OF NOVICES
203

Figure 4: Know-how information sharing a process and effects.
4.1 Evaluation Design
We conducted a two-year trial experiment at a care
center to evaluate the externalization of know-how
information and sharing by KISS.
(1) Outline
The following is the experiment’s outline:
• Nine users: one nurse, four care workers,
and four care takers. Four were interviewed.
• The place was an in-home care support
center.
• The period ran from April 2007 to March
2009.
• A Notebook computer was used.
(2) Method of Evaluation
This function was evaluated by analyzing the use
and interview results. The evaluation method of the
educational effects was the analysis of user
interview results.
(3) Form of Trial
Although KISS trials in care facilities could have
various forms, we tried the following four forms:
• Users observed a two-dimensional
arrangement of 106 examples and compared
why the example’s position is near or far by
reviewing the KOMI chart, for example.
• Users drew up a care plan and compared it
with a model example.
• Nurses or care workers assessed a care client,
and users drew up a care plan and compared
it with a model example and other care plans
and recorded awareness.
• Users referred to the awareness documents of
co-workers and recorded their awareness.
(4) Evaluation Item
Since a system must be evaluated from both its
function and educational effect sides, we asked
about the attainment of externalization, the sharing
of know-how information, and the educational
effect.
The sharing process of know-how information
with our system is shown in Figure 4. A user
inspects the documents of co-workers and filters
information to share. In the process, highlighted
examples are set as objects of a document to be
referred to. When a filter is passed, it is shared for
the first time. Furthermore, improvement in
individual technology is achieved by utilizing this
information. The result is interlocked with an
organization’s rejuvenation by being reflected in an
organization. Furthermore, we expected users to
notice the differences, and the document contents
were also affected by individual improvement in an
organization’s technology and rejuvenation.
4.2 Evaluation Results
The trial’s evaluation results are divided into
externalization of know-how information and know-
how information sharing.
4.2.1 Externalization of Know-how
Information
To verify whether know-how information was
externalized, the results of awareness documents and
interviews were analyzed.
(1) Awareness Documents
All awareness documents were coded and
categorized using the Grounded Theory, which is
one methodology of qualitative research. From the
results, the documents were categorized into three
types of differences: care environment differences,
individual differences, and basic plan differences.
Typical awareness documents are shown in Table 1.
• Environment differences of offered care
service: Individuality did not appear enough
in the hospital’s care plan. In the hospital,
care that directly addresses the client’s life
was mainly performed. Awareness about
how to be concerned for care clients is
obvious.
Chain reaction
induction
Similarity
Empathy
Affirmation
validity
Importance
selection
Individual
effect
Improvement
in skills
Effect on
organization
Rejuvenation of
organization
Discovery
Awarenes
s
d
Cases
Sharing
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Table 1: Example of document awareness.
Category Contents
Environment Care plan is incorporated in which the direction of home care captured a client's individuality, for
example, hobbies etc., more than the hospital. In the hospital, care about direct work on the life is
mainly performed
Person Care taker should be better understood. When making a care plan, differences appear between
experts and beginners in how detailed viewpoint targets are held up.
Basic plan When looking at the grand assessment, she wrote about the direction of life changes, the harmful
factors, and the remaining abilities, but she didn’t write about a basic care plan. I thought that
alleviating the user’s stress should’ve been addressed.
• Differences arising from those involved care
in: Care taker should be understood more.
A difference also arises between experts and
beginners. Awareness by differences in
occupational descriptions, experienced
persons, beginners, etc. is recorded.
• Basic plan differences: a user wrote about
the direction of life changes, the harmful
factors, and the remaining abilities, but she
didn’t write about a basic care plan.
Relieving stress is also required. The user
noticed the differences between the
assessment results and the basic plan
derived from it.
When beginners noticed the differences from experts,
the know-how information at the on-site level could
be externalized. Moreover, the number of times
KISS was used increased. A difference was found
from people from different environments and with
different basic plans. A tendency in which a
viewpoint moved to an important element for
planning an important element was seen, suggesting
that user viewpoints evolved.
4.2.2 Know-how Information Sharing
Sharing know-how information was verified using
the interview results with users about the directly
supported function.
(1) Assessment Display Results by Several Users
Comparison examinations of the care plans of co-
workers explain this difference. Moreover,
discussion considered the differences in co-worker's
viewpoints and utilized them. Improvement in user
capabilities is accepted from these results.
Furthermore, users answered that comparison
examinations while using this function with a co-
worker resembled mini study meetings or
conferences, suggesting that this function effectively
shared know-how information and that realized
sharing can be checked.
(2) Referring to other’s Awareness Documents
The items used to evaluate the realization of know-
how information sharing by referring to awareness
document are the conditions that determine the
sharing properties shown in Figure 4. User answers
to those conditions are shown in Table 2.
• Chain Reaction and Induction: All users
looked at the awareness of others and said
they noticed something.
• Similarity: Several users answered that they
were similar with the same awareness.
• documents because they were working in
the same organization.
• Empathy: The user was flexible,
sympathized with different ideas, and
accepted them.
Table 2: Attainment of know-how information sharing.
Question Answers
Chain reaction
and induction
“At visiting times, since the client situations were different, I looked at the chart to create changes.”
“I was influenced by the difference of the amount of information, and the current time and whether one day of a
client is seen correctly, and he noticed that it appeared differently, even if the same client's chart was created.”
Similarity “Although clients have lifestyles and illnesses, if seen diagrammatically, they can be arranged nearby. He noticed
and we agreed about the document.”
Empathy “I wondered why Ms. M's awareness was seen. Her viewpoint was different from mine, so there would also be
such a view.”
“In the hospital’s care plan, awareness questioned why there was such a low judgment of motion from the
recognition side, although a movement was seen, and I also looked at the example and felt the same.”
Affirmation and
validity
“The client's appearance changed due to the difference between how to talk to the concerned client and how to be
concerned.”
Importance and
Selection
“Care performed at home and in a hospital is different. If this difference is known, it will become an advantage
for the in-home care support center.”
Discovery “I observed from a different angle and discovered.”
EXTERNALIZATION METHOD AND ITS EVALUATION OF KNOW-HOW INFORMATION FOR CARE
PLANNING PROCESSES BY AWARENESS OF NOVICES
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• Affirmation and Validity: As compared with
the knowledge acquired from a familiar
experience of it.
• Importance and Selection: The user always
judged and chose the importance based on
relations with his everyday practice.
• Discovery: Users are thinking about why the
difference arose. Moreover, they answered
the following to determine whether know-
how information was sharable.
All the conditions that determine shared properties
are satisfied by these results; know-how information
was shared. Moreover, improvement in a user's
capability can be checked from answers that include
the following: “Being at home will become an
advantage if the difference between being home and
in the hospital is revealed,” and “I observed from a
different angle and discovered.
4.2.3 Know-how Information Sharing Effect
The interview results about the items for evaluating
the effect of shared know-how information are
shown below.
(1) Were new information, ideas, and knowledge
created? “Expressing, writing, and externalizing
awareness by language are difficult, but important.”
(2) Were new knowledge and ideas performed?
“Since awareness is important, I am teaching
newcomers to record it.” “We are going to devise a
format that can easily record awareness at care
facilities.”
(3) Did change arise in the organization? “User
noticed that conversation with a care client is critical,
and even though it is time-consuming, he doesn’t
regret such time. Everybody learned to record
conversation contents.” “By comparing with a model
example, I became aware of the care level and have
confidence now.” “I regarded the client as carrying
out assessment and I had thorough discussions with
the client.” These results suggest that organizational
growth or rejuvenation is checked from
improvements in individual capability by sharing
know-how information.
5 CONCLUSIONS
In this paper, we described the method and its
evaluation of a know-how information sharing
system (KISS) for a care planning process.
To
externalize and share know-how information, our
system visualizes and observes care plans drawn up
by experts in various forms that allow beginners to
notice the differences between novice and expert
plans. In a two-year trial, the possibility of
externalizing and sharing know-how information at
the on-site level was discovered when beginners
noticed differences from experts using KISS.
Furthermore, organization growth and the possibility
of rejuvenation were verified with improvement in
individual capabilities by externalization and sharing
of know-how information. These results verified that
care management education is supportable by
computer. Future works will confirm the
effectiveness of KISS in educational facilities and
build a large-range Web environment for it.
ACKNOWLEDGEMENTS
This work was supported in part by Grant-in-Aid for
Scientific Research (C) No.20500808, from the
Japan Society for the Promotion of Science.
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