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

Healthcare.

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.

1 INTRODUCTION

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

298

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

collaborate.

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 LITERATURE REVIEW

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,

1989).

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

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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.,

2005).

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

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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 RESEARCH METHODOLOGY

AND DESIGN

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.

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4 RESEARCH FINDINGS

4.1 Process of Sharing Patient

Knowledge

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

knowledge.

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

requirements.

“[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

15.35

Differences in terminology make KS particularly

difficult, since TCM and WM professionals cannot

understand each other’s language. Patient

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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

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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

knowledge.

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

knowledge.

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.

5 DISCUSSION AND

CONCLUSIONS

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

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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

environment.

 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

barrier.

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

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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

communication.

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

communities.

ACKNOWLEDGEMENTS

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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