Knowledge creation practices at organizational boundaries : the role of ICT in sickle-cell care for tribal communities

Purpose: This paper aims to examine the role of information and communication technology (ICT) in the knowledge creation practices adopted by a health care organization. The organization is delivering care to patients of a genetic disorder, called the sickle cell, in tribal communities. The paper identifies how ICT intermediates knowledge creation practices across the organizational boundaries wherein tribal patients, front-line counselors and expert physicians interact, which then produces context-specific, evidence-based medicine (EBM). Design/methodology/approach: The knowledge-in-practice approach is adopted to conduct an ethnographic study of sickle cell care practices in a non-profit health care organization in Western India. The analysis focuses on ICT-mediated interactional practices among the physicians, front-line counselors, tribal patients and their families, for more than a year-long observation. These are supplemented with informal and formal interviews, archival records and vignettes based on several episodes to explicate the key knowledge creation practices. Findings: Technology-mediated informative interactions at organizational boundaries can bridge socio-linguistic and interpretive barriers between actors, while also providing a generative structure that leads to the creation of longitudinal clinical evidence about a rare genetic disorder. Three specific ICT-entwined knowledge creation practices emerge, namely, knowing the community, increasing interactional engagement and constructing gradients of socio-clinical history. These practices generate organization-wide knowledge about the social and clinical dimensions of the genetic disorder. The findings are presented through vignettes and a novel conceptual framework. Research limitations/implications: This study identifies various useful knowledge creation practices in health care delivery for resource-constrained emerging economy contexts. Further, the study suggests that the involvement of local front-line actors and ICT can become important resources in the delivery of health care in these settings. Originality/value: A novel framework is developed which demonstrates knowledge creation at organizational boundaries wherein the actors use ICT-based practices for effective delivery of health care. The proposed framework may be used by health care organizations in similar contexts providing care to marginalized communities.