Francesco Marinucci
Research Project
OMDE670
Spring 2014
Page 1
The Role of Distance Learning and Knowledge Management in the Global Health
Laboratory Diagnostic Market
Francesco Marinucci
University of Maryland University College
OMDE 670 Capstone Project
Spring 2014
Francesco Marinucci
Research Project
OMDE670
Spring 2014
Page 2
Table of Contents.................................................................................................................2
Abstract................................................................................................................................3
Introduction…………..........................................................................................................4
Literature Review................................................................................................................7
The Knowledge Age ...............................................................................................7
Knowledge Management ........................................................................................8
The SECI model...........................................................................................8
Socialization.................................................................................................9
Externalization...........................................................................................10
Combination...............................................................................................10
Internalization............................................................................................10
The concept of ‘Ba’ ..................................................................................11
Distance Learning and eLearning......................................................................... 12
Situated Learning.......................................................................................13
Learning Objects........................................................................................14
Mobile Learning.........................................................................................16
Authentic Learning....................................................................................17
Pedagogy of Mobile Learning...................................................................17
Corporate Learning...............................................................................................18
Biomerieux University...............................................................................18
Sysmex Academy.......................................................................................19
Becton Dickinson eLearning.....................................................................19
HemoCue Learning Center........................................................................20
Analysis .............................................................................................................................21
Conclusion.........................................................................................................................28
References..........................................................................................................................33
Francesco Marinucci
Research Project
OMDE670
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Abstract
The fast growth of diagnostic technologies developed in the last decade has
increased the access to laboratory diagnosis and improved the management of diseases
also in more difficult markets. However, the impact of these technologies is hampered by
the lack of knowledge and new set of skills required to end users and local partners to
handle them at their full potential. New business strategies have been developed to tackle
these gaps especially by introducing knowledge transfer activities as part of private
companies’ strategies in emerging markets.
The goal of this work is to provide the rationale for offering distance learning
activities for companies working in the diagnostic sector in emerging markets, and how
their impact is strictly linked to the knowledge management system within the company.
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Research Project
OMDE670
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Introduction
The purpose of this research is to describe the competitive advantage of distance
learning and e-learning activities that clinical laboratory equipment manufacturers should
consider for strengthening their presence and expanding their market share in sub-Sahara
African markets. At first the research focuses on the potential interaction between
knowledge management and distance learning in creating a competitive advantage for
laboratory equipment manufacturers working in the clinical laboratory sector in emerging
economies. In particular, the literature review analyzes the role that knowledge
management plays, or might play, in generating course best content. As next area, the
research concentrates on the most appropriate combination of delivery mode and learning
pedagogy that motivates end users in these settings. Lastly, a section on mobile learning
reviews mobile learning as the potential, most suitable approach for laboratory equipment
manufacturers aiming at establishing distance learning activities in emerging economies.
Nowadays the sales of most clinical diagnostic tests occur globally. However, the
fast growing innovation in the area of laboratory diagnostic technologies is facing novel
dynamics as more affordable, innovative products reach new markets. Very often the
demands of the consumers in a company’s home country shape the incentives of the
company to innovate with the consequence that end users in the new markets might find
challenges in accepting and adopting the new technologies (Fabrizio & Thomas, 2011).
Factors such as health policies, health systems, laboratory networks, and IT
infrastructure, which characterize the environment in sub-Sahara African countries,
should drive diagnostic companies in rethinking their business model accordingly. As
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highlighted by Eyiring, Johnson, and Nair (2011), affordability and access are the two
most important components to redirect demand in emerging markets, however additional
measures are needed in the high-tech, fast evolving biomedicine sector. In particular, a
key factor would be the significant transfer of knowledge for improving end users’
acceptance of new technologies to efficiently market new products. In this scenario, for
laboratory equipment manufacturers to compete in this global scenario there is need to
invest in dynamic systems allowing to manage knowledge and to transfer it to customers
in a timely manner. By definition, distance learning and e-learning fulfill the requirement
of providing access to learning when the source of knowledge and the beneficiaries are
separated by distance and time.
New business models for laboratory equipment manufacturers in knowledgelimited markets should comprise comprehensive packages of distance learning activities
tailored to meet local needs for in-service, self-paced professional development of
laboratory professionals. The interaction between knowledge management and distance
learning can result in an effective model to produce and ensure timely access to up-todate training material by end users to increase their satisfaction and loyalty.
In spite of the well-established array of models and practices developed and
implemented in different environments, especially in higher-education enterprises, other
factors must be taken into account for effectively integrating distance learning and elearning into the new business model. The course developers have to be aware of the
cultural background of trainees by being mindful of the fact that “theories developed in a
given culture reflect the main patterns of that culture” (Beugré & Offodile, 2001, p.536).
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Research Project
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The knowledge about local teaching practices and learning styles determines the pattern
of innovations to be generated. There are several potential challenges that can harm
distance learning and e-learning activities, however the absence of global mindsets and
the lack of understanding on how the cultural factors can affect the adoption of
technologies is the most detrimental (Ritchie, Drew, Srite, Andrews, & Carter, 2011).
The acquaintance of local digital natives with IT devices different from those available in
course developers’ home country has contributed to the development of new skills and
ways of receiving and assimilating information (Prensky, 2001).
The research comprises a review of the current literature on knowledge
management and distance learning in the corporate sector followed by an analysis and
discussion. Initially it will focus on new business models in emerging markets in the socalled Knowledge Era and it will also explore knowledge management and organizational
learning. It will then continue by covering a few areas of distance learning and e-learning,
such as situated learning, learning objects, and mobile learning, which in the author’s
opinion play an important role in the settings of the research. Lastly, the literature review
will examine some existing distance learning and e-learning courses offered by
laboratory equipment manufacturers. The analysis part of the research will integrate the
information retrieved from laboratory equipment manufacturers’ websites on the current
distance learning activities with the areas of the literature review. The main goal of this
comparison with the literature review is to highlight pros and cons of the real cases. The
outcomes resulting from the analysis of the two methodologies above will be used to
formulate some key recommendations aiming at showing the competitive advantage of
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Research Project
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Spring 2014
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integrating distance learning and e-learning with knowledge management for laboratory
equipment manufacturers working in emerging economies.
Literature Review
The major goal of the literature review is to introduce readers to some concepts
related to knowledge management and distance learning that in the author’s opinion fit
very well in the envisioned conceptual model summarized at the end of the manuscript.
In particular, the literature on knowledge management focuses on one specific model that
shows the potential of redefining private companies’ knowledge creation and sharing
processes in the context of the Knowledge Age.
The Knowledge Age
The main characteristic of the current Knowledge Age is the relationship between
users and information. The quick availability of information on the WWW offers
increased possibilities, but also challenges, both to company workers and company
customers due to the independent access to the Internet. The opportunities offered are
numerous and it is to the individuals’ responsibility to “be able to work productively in
collaborations with others. Most importantly, they need to be able to think and learn for
themselves, sometimes with the help of external authorities and/or systems of rules, but,
more often, without this help” (NZCER, 2013, para 8).
Therefore it is of paramount importance for private companies to keep their
competitiveness by investing in human resources development so to nurture the
knowledge of their own workers. As discussed by Hatch and Dyer (2004), human capital
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contributes “to competitive advantage due to its inimitability based on its intangible,
firm-specific, and socially complex nature” (p.1157). Knowledge is key to organizations
and due to the fast evolving of the clinical laboratory diagnostic sector it represents the
most competitive advantage since it is the most valuable resource. To keep these assets,
the private sector has invested in so-called corporate universities where “market-driven
innovation and businesses and organizational innovations” are becoming the main
subjects (Rademakers, 2005, p.133).
Knowledge Management
However, corporate universities are only the iceberg tip of very complex business
management strategies of which knowledge management and organizational learning are
the two main pillars in regard to knowledge acquisition, development, storage, transfer,
sharing, and utilization. There are numerous definitions of knowledge management
mainly coming from different perspectives such as business, management, intellectual,
and cognitive science. Regardless of the definition of knowledge management,
knowledge can be divided into tacit and explicit; the former tends to exist in the head of
workers, the latter represents content that is captured on tangible or concrete media
(Polany, 1967).
The SECI model. Among the different models of knowledge management, the
Nonaka and Takeuchi (1995) model, also known as Knowledge Spiral Model, relies on
the tacit/explicit spectrum of knowledge forms to create knowledge and create
innovation. Sharing personal knowledge within the company is at the core of their
knowledge management model. According to Nonaka and Takeuchi, the process of
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creating knowledge is ongoing and it can take place in an unexpected and unplanned
way. In particular they support the concept that “knowledge creation consists of a social
process between individuals in which knowledge transformation is not simply a
unidirectional process but it is interactive and spiral” (Nonaka and Takeuchi, 1995,
pp.62-63). Overall, the Knowledge Spiral Model – also known as SECI model - is a
dynamic activity where knowledge flows across individuals, within groups and the
organization itself, and where the conversion of tacit knowledge held by individuals
occurs in the following different modes:
o Socialization
o Externalization
o Combination
o Internalization
Socialization. The socialization mode includes social interactions as a way of
sharing knowledge. The reason for companies’ creation of social events where employees
can informally share their knowledge is to stimulate tacit-tacit interactions. Coupling a
tutor and an apprentice during day-to-day routine work can also facilitate this interaction.
This approach is crucial for creating knowledge and to prevent the risk of losing it in case
of employees’ retirement. Knowledge transfer can also occur within knowledge intensive
community and social networks, where newcomers play an important role as they bring
in additional knowledge and act as intermediaries (Guechtouli, Rouchier, & Orillard,
2013). However, while creating knowledge through socialization is very effective, it is
very challenging and time-consuming to disseminate knowledge using this mode only.
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Research Project
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Externalization. This mode makes possible to convert tacit to explicit
knowledge. A third party is often needed for this process to happen and to stimulate the
externalization process from the single knower by “taking the shapes of metaphors,
analogies, concepts, hypotheses, or models” (Nonaka & Takeuchi, 1995, p.4). Once that
knowledge has been externalized and made tangible, it is easier to make it available
within the organization.
Combination. At this stage of the model discrete pieces of explicit knowledge are
recombined together in new and more accessible forms, which are easy to classify and
sort by using a knowledge management system. No new knowledge is created but rather
refined and consolidated in a way that can be stored and reused. In case of enterprises
working globally where it is crucial to transfer know-how across multiple cultures the
combination mode should take into account the challenges in different contexts faced by
the receivers. The process of knowledge creation and migration in cross-cultural contexts
can occur in a variety of ways but “unless semantic communication is enhanced and
structural coupling takes place, knowledge, especially tacit knowledge, is unlikely to be
successfully migrated” (Iles, Ramgutty-Wong, & Yolles, 2004, p.646).
Internalization. The last conversion process occurs when tacit knowledge goes
back to individuals by stimulating a change in behavior, practice, or mental model. The
completion of this step, where the models or technical know-how are shared among
employees or community of practice, lays the foundations for the Knowledge Spiral
Model to start again. Training programs and mentoring are traditional internalization
mechanisms that organizations use to help individuals to absorb specific lessons and best
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Research Project
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practices (Kale & Singh, 2007).
The concept of “Ba”. The SECI model is an ongoing process in which exchange
and transformation of explicit and tacit knowledge occur. To better describe this process
Nonaka and Konno (1998) have introduced the concept of ba by describing four types of
ba, each corresponding to one stage of the SECI model. The term ba, which can be
roughly translated in English with the word place, indicates the space – not necessarily a
physical space – shared by individuals and teams where the creation of knowledge and
production of creativity take place. Nonaka and Konno define ba as the “platform for
resource concentration of the organization’s knowledge assets” (p.41). They also assert
that “ba exists at many levels, just as the ba for individuals is the team, the organization
in turn is the ba for the teams. Finally, the market environment is the ba for the
organization” (p.41). The ba corresponding to the combination phase is named Cyber ba
and it represents the collaborative environments where the interaction between
individuals and teams supporting the arrangement of discrete pieces of explicit
knowledge occur. From Rice and Rice’s (2005) perspective the Cyber ba in the
combination mode “often employs information technology to facilitate asynchronous
learning and the contribution of various groups and constituencies in the development of
an organizational knowledge asset” (p.677-678). In their contribution they also
highlighted how knowledge-based capabilities can also exist within an organization’s
broader relationships with stakeholders.
Distance Learning and e-Learning
Once the organization defined the processes in which sharing and transformation
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Research Project
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of explicit and tacit knowledge occur, it is important to embed these into a broader
learning process involving not only the company workers but also the company
customers. In this context distance learning and e-learning ensure access to learning when
the source of knowledge and the learners are separated by distance and time. Standard
procedures for identifying specific needs of target groups and developing detailed
learning objectives have to be proposed, tested, and modified over time to meet changing
customers’ learning demand (Holmberg, 1985; Moore, 1989). Regardless of the
theoretical approach adopted by distance educators, the learning process is determined
more by content and instructional strategy than the delivery mode and the type of
technology adopted (Clark, 2001). However, the combinations resulting from the
adoption of different pedagogical theories, learning strategies, and technologies should be
evaluated case by case with the overall goal of providing specific groups of learners the
most effective experience. As pointed out by Ally (2008), the approach to be followed by
instructional designers and distance educators should encompass strategies to “motivate
learners, facilitate deep processing, build the whole person, promote meaningful learning,
encourage interaction, provide relevant feedback, facilitate contextual learning, and
provide support during the learning process” (p.19). Distance learning in organizations is
far more complex and it requires different training approaches able to promote and
support the learning process. The complexity mainly derives from the quality of
interactions between individuals and the capacity and willingness of each single
employee to share tacit knowledge (Hwang, 2003). However, in the author’s conceptual
model the distance learning in organizations should include the company customers, who
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in this specific case are mainly laboratory workers. Among the different instructional
designs and teaching strategies available the top three more supportive of the author’s
model are situated learning, learning objects, and mobile learning.
Situated learning. The only common trait to most distance learners is that they
are adult learners engaged in life-long learning. This aspect finds its theoretical
background in the constructivist school of learning where the learners play an active
rather than passive role within the learning process. The constructivist approach
emphasizes the importance for learners to participate in the learning process and to
interact with the surrounding environment so to create meaning from their own
experience. As per Jonassen and colleagues (Jonassen, Davidson, Collins, Campbell, &
Haag, 1995) description, “meaning making, according to constructivists, is the goal of
learning processes; it requires articulation and reflection on what we know” (p.10).
Having laboratory workers as the target group of learners provides some common
background characteristics, such as content of pre-service training, similar physical
working environment, and identical standards (Standard Operating Procedure, Good
Laboratory Practice). In this scenario, the training provider can easily offer the learners
targeted activities to transfer course content to real-life situations. In the case of clinical
laboratories the real scenario can be narrowed to the use of single equipment but it can
also be broadened to more complex situations such as Quality Management System or
Clinical-Laboratory Interface. The well-defined and limited physical environment of the
laboratory is where the majority of real-case scenarios occur and it is where learners can
easily develop the problem-solving attitude proper of the constructivist learning
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(Anderson, 2010).
Learning Objects. The transmission of the information, especially if limited in
terms of applicability (i.e. clinical laboratory operations) and knowledge domain (i.e.
how to operate laboratory equipment), can take place through the repeated use or the
combination of several learning objects. This term is often used to indicate “discrete
chunks of reusable materials of activities that can become together with other learning
objects to construct learning contents” (Cakiroglu, Baki, & Akkan, 2012, p. 181). The
repeatability of the same task under increasing levels of complexity can be achieved by
using the same learning objects in different scenarios. A learning object is defined “as
any digital resource that can be used and re-used to achieve a special learning outcome or
outcomes” (Kraus & Ally, 2005, p.2). One characteristic crucial for the reuse of learning
objects is what Boyle (2003) called de-coupling, which means the minimal binding
between units of learning. The most challenging task for instructional designers is to
develop a rich, integrated learning experience by using reusable learning objects. More
important for Boyle is the issue of ‘repurposability’, which he defined as the options
offered by “cohesive, decoupled, and pedagogically rich” (p.49) components for their
adaptation to local contexts. Ideally these learning objects should be part of a
comprehensive internal repository where corporate distance educators and instructional
designers have access to select and assemble them in the most effective way for a definite
target audience and specific learning objectives. This approach differs from the term
Open Educational Resources (OERs) widely used nowadays to indicate resources of high
quality freely available on the WWW (Scanlon, 2011).
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An important attribute of learning objects is their user-friendliness, which
Oppermann (2002) classified by using the following four dimensions: the look, the feel,
the access to tools and services, and the communication and cooperation support. These
four dimensions should be carefully evaluated by keeping well in mind end users’
experience as independent learners and their socio-economic status and geographic
location (Bigley, Hosein, & Myemba, 2009). However, according to Krauss and Ally
(2005) the “problem with promoting the re-purposing of learning objects is that it runs
counter to instructional design best practices” (p.16). To partially mitigate this issue, the
evaluation of learning objects should be part of any well-planned, comprehensive
instructional design process. Leacock and Nesbit (2007) developed the Learning Object
Review Instrument (LORI) with the aim of standardizing the evaluation of and making
the quality of multimedia learning objects comparable. In regard to reusability of learning
objects the LORI rubric provides developers useful information to maximize their
reusability without affecting the usefulness. The LORI model was developed to meet the
increasing demand for standardized procedures able to ensure quality assurance and
quality improvement for learning materials. However, the quality of distance learning and
e-learning activities should not be limited to the use of tools like the LORI model only,
but it should be ingrained in the quality management system of the course provider. The
online quality management system piloted by Fresen and Boyd (2005) showed the value
of using management information for evaluating the impact and return on investment
caused by e-learning activities.
Mobile Learning. The location of the majority of clinical laboratories in sub-
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Saharan Africa is either rural or peri-urban. Reliable access to the Internet is very often
limited to health facilities in the capital cities and the major urban centers, while the
coverage of mobile phone networks is good in the majority of the country. This scenario
makes mandatory the exploration of optional approaches to deliver course content and
facilitate learner-provider communication. A major valid alternative to Internet-based
learning is mobile learning, which has the valuable feature of being able to reach learners
out of conventional distance education programs’ reach. Mobile devices and smartphones
are radically changing the way people access information. In emerging and developing
economies this is the main way, if not the only, the majority of people, especially the
young generations, communicate, share information, and interact (Elias, 2011). As
identified by Aker and Mbiti (2010), two of the mechanisms through which mobile
phones can produce economic benefits in sub Saharan Africa are the improvement of
access to information and the use of mobile applications to deliver education. However,
as per Kukulska-Hulme’s (2007) research findings, it is of crucial importance that mobile
devices are designed with educational application in mind.
It is noteworthy that the despite the technical challenges mobile learning presents,
such as device variability, slow download speed, size of the screen, and limited memory,
it also offers a distinctive set of opportunities. These can be divided into technical
opportunities, in contrast to the challenges listed above, and in business opportunities.
The latter encompasses numerous fields including distance education. Among the
technical advantages there are higher network access in comparison to the Internet and
continuous and situated learner support.
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Authentic learning. In his analysis, Traxler (2007) emphasized how mobile
technologies can be extremely useful to enhance situated learning and how “mobile
learning is uniquely suited to support context-specific and immediate learning” (p.18).
However, when learning is situated within a specific environment, i.e. clinical laboratory,
it is much easier to support the learning process by involving real-world problems. If the
activity that takes place within the laboratory is authentic, it is very likely that learners
would find it relevant and interesting. Ogata and Li Hui (2008) support the approach of
authentic learning as valid pedagogic theory of mobile learning. They strongly advocate
for the combination of different methodologies and styles as an approach for realizing
“right time and right place learning” (p.73).
Pedagogy of mobile learning. A major advantage of using mobile devices for
teaching and learning is that both providers and learners are very familiar with the
technology. The fact that smartphones are used for the most diverse functions, from
online banking to social networks, makes their usability for education very high.
However, it is important to carefully evaluate the role of mobile devices within the whole
instructional design, especially because their introduction always requires significant
cultural change to fully discern their potentialities (Trifonova & Ronchetti, 2003;
Kukulska-Hulme, Sharples, Milrad, Arnedillo-Sanches, & Vavoula, 2009). Mobile
learning requires practitioners to revisit the existing theories and adapt them to the mobile
technologies to define their educational applications. In this regard, Park (2011)
contributed significantly with the development of a pedagogical framework by combining
elements of transactional distance and learners’ activities. This classification scheme
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provides instructional designers and instructors some valid elements for designing and
implementing mobile learning. However, among the many factors contributing to the
implementation of mobile education, learners’ learning styles are the most variable and
unpredictable, and flexible and adaptable options for content access, users’ interaction,
and usability should be made always available.
Corporate Learning
In order to introduce the conceptual model below the author has selected some
examples of distance learning and e-learning activities from the private sector for
comparison and analysis in the next section of the manuscript. A major selection criterion
is the presence of well-established business in developing and emerging economies.
Biomerieux Education Center
Biomérieux is one of the biggest clinical laboratory diagnostics companies and a
world leader in clinical microbiology. They have a strong presence worldwide with
regional offices in each continent. The Biomérieux Education Center serves as a portal
where end users can have easy access to a collection of educational resources. They offer
online training courses in the following different formats: continuing education programs,
webinars, product demos, and symposia. The last three consist of videos of variable
length addressing different topics either related to the use of a specific product or a health
issue. All the demo material on their diagnostic products consists of short (2-5 minutes)
real world videos combined with audio. The format of the webinars and the symposia
consists of power point presentations with audio. The continuing education programs
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constitute the training offer of Biomérieux Inc. as approved provider of accredited
courses. While the delivery mode is identical in terms of videos and audio material,
participants have access to the learning objectives and need to register and complete the
evaluation to receive their Professional Acknowledgment for Continuing Education
credits (Biomerieux, 2009).
Sysmex Academy
Sysmex is one of the world’s leading healthcare companies, and the global leader
in hematology. Its operations worldwide are managed through five independent regional
headquarters. The Sysmex Training Academy is a high quality, industry-leading training
support service designed and developed as a direct result of feedback from customers on
their training needs. It is the company’s ambition that their website becomes a leading
source of information for their areas of expertise, and for hematology in particular.
According to the company’s website in the Sysmex knowledge center it is possible to
find all sorts of information on many topics in many formats. However, each analyzer
purchased is automatically accompanied by a number of training credits, to allow end
users to arrange the most appropriate training to suit their needs. Sysmex customers can
choose which course best suits their level of expertise, also- basic, comprehensive or
advanced. For the transfer of skills they offer hands-on trainings at their training centers
or on-site (Sysmex, 2014).
Becton Dickinson eLearning
Becton Dickinson Biosciences is a world leader in bringing innovative diagnostic
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tools to laboratory professionals and clinicians who are involved in disease management.
The training options cover both instruments and applications, which are offered either as
hands-on instructor-led training or e-learning in a self-paced study. The course content is
updated regularly to allow end users staying current with the latest technology. BD
introduces their self-paced e-learning courses as supplemental support to their end user
training courses by using them either for basic learning or to reinforce or refresh what is
learned in class. Their web-based introductory course to flow cytometry has thirteen
sections available on an interactive course page that can be navigated by the learners. The
media used for course-content are video, audio, and text. At the end of the course there is
a quiz followed by a summary module highlighting the learning objectives. The modules
are accessible in any order and, even if there is no interaction between provider and end
users during the course, the learners are invited to provide their feedback to improve the
course. The dedicated page for course feedback asks learners to grade the following four
areas: course content, presentation and design, navigation and interface, and course
effectiveness (Becton Dickinson, 2014).
HemoCue Learning Center
HemoCue is a Danish company specialized in point-of-care testing equipment
used in more than 130 countries. The Learning Center is part of their customer support
services aiming at providing healthcare professionals quick access to essential training
and current best practices. Their training offerings comprise onsite educational activities
tailored to customers’ needs and three online products namely videos, synchronous
seminars online on demand, and e-learning. The latter, named HemoCue Web Academy,
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comprises a free service for anyone interested in their products. At the time of last access
none of the trainings in their portfolio was accessible (Hemocue, 2014).
Analysis
In the following section the author carried out an analysis aiming at laying down
the foundations for his conceptual model. In particular, the main goal of the analysis is to
highlight pros and cons of the real cases. The outcomes resulting from the analysis will
be used to formulate some key recommendations aiming at showing the competitive
advantage of integrating distance learning and e-learning with knowledge management
for laboratory equipment manufacturers working in emerging economies.
Integrating Knowledge Management and Distance Learning
Both knowledge management and distance learning provide knowledge to end
users in different formats by using different technologies. However, the former is more
focused on content management and knowledge sharing, while the latter favors learners’
scaffolding by providing structured contents and interaction opportunities. A major step
in the effort of integrating the two areas would include a partial overlapping of systems’
functions and employees’ capacities between knowledge management and distance
learning activities. In the author’s view, this should occur during the combination stage of
the SECI model where the discrete pieces of explicit knowledge should be recombined by
having in mind the following dual target. First, the refinement and consolidation of
knowledge should serve for internal purposes such as storage and reuse. Second, the
recombination process should include and additional step where the knowledge created
by the company is filtered to meet end users’ needs and the content designed for distance
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learning. By adding this step the knowledge management process can also function as
production of knowledge bites resulting in a kind of repository for content to be used for
distance learning. The result would be that knowledge creation occurs with knowledge
management practices, while its dissemination follows an internal and an external path
through knowledge management system and distance learning respectively. This dual
process implies the presence of structuring and classification mechanisms able to
differentiate, channel, and save the knowledge created for the two different uses (Yilmaz,
2012).
However, the externalization process of knowledge through distance learning can
be effective only if driven by highly trained professional workers able to recognize the
enabling and disabling factors of knowledge management activities. In their work aiming
at classifying enablers and enemies for knowledge management projects, Apostolou and
Mentzas (1999) drew the conclusion that knowledge is contextual and local, and is
socially constructed. The prevailing use of Web 2.0 technologies, especially social
networks, should be used to facilitate the socialization component of the SECI model in
the creation of knowledge. The lack of barriers and the ease of access to social
environments through the World Wide Web should expand, in the author’s opinion, the
Cyber ba as described above. In particular, the creation of social spaces open to both
knowledge enablers inside the company and knowledge receivers outside the company
(i.e. end users of laboratory equipment) can offer unexplored possibilities for these two
networks to form new, single forms of knowledge. The inputs from and the exchange of
experience with end users can be extremely helpful to the company to optimize the
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refinement and consolidation process. This can result in a final step where the knowledge
is tailored to end users’ needs by using their own contribution as expressed in the social
spaces.
The Digital Divide
However the promotion and the utilization of this expanded social space poses
some challenges. A major factor to be taken into account is the computer literacy or,
more in general, the technology literacy of the end users from sub-Saharan Africa. While
their contribution to the socialization process can be very valuable to the creation of
contextual and local knowledge for these markets, the so-called Digital Divide can seem
insurmountable if only a few technologies, such as computers and the Internet, are used
(Unwin et al., 2010). Therefore, to create the social space and engage end users in the
discussion it would be appropriate to broaden the spectrum of technologies by adopting
those more familiar to the target audience. However, critical questions going beyond the
availability and affordability still remain, especially in regard to the “complex issue of
readiness of providers and consumers” (Beaudoin, 2007, p.444). In the author's opinion,
for narrowing the global digital divide, private companies working in the diagnostic
sector in emerging markets should adopt an approach that effectively fits in the local
scenario.
Global Goals and Local Approach
The trend followed by many manufacturers of introducing of computer-controlled
and point-of-care devices able to wirelessly send data from remote location to central
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database will very likely “help developing countries in leapfrogging certain stages of
technological development” (Fuchs & Horak, 2008 p.111) and “overcoming the new
digital divide” (Warschauer & Matuchniak, 2010, p.213). However, it is noteworthy that
also the urban-rural divide regarding human resources exists “with greater numbers and
better trained health workers concentrated in urban areas, to the detriment of rural areas”
(Anyangwe & Mtonga, 2007, p.95). While remote access technology can be effective in
delivery training, it is also crucial to use different technologies at country level as the
distance learning approach moves from central location to more rural areas (Moran et al.,
2013).
In this scenario the adoption of handheld devices, especially smart and mobile
phones, can offer great opportunities to reach out to laboratories at different levels of the
health system (Aker & Mbiti, 2010). A major advantage would be the non-disruption of
health services due to the situated learning approach taking place in the working
environment. It also tackles the common issue with short courses and workshops being
disconnected from their context when located outside the working environment. This
approach offers the possibility of facilitating the “simultaneous integration of new
conceptual knowledge with practice, through assignments and projects in which students
apply new approaches to familiar problems” (Alexander, Igumbor, & Sanders, 2009, p.5).
One important affordance of smartphones and other handheld devices is that
different media can be used to deliver content. By connecting to the Internet or mobile
phone network the resources can also be downloaded and accessed offline. However,
appropriate design of the learning objects is key to have them effectively used to achieve
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the learning objectives. The conceptual model developed by Churchill (2011)
summarizes very well three major critical areas to be addressed, namely design for
presentation, design for small screen, and design for learning uses. The recommendations
of Churchill’s (2011) conceptual model present possibilities for learning-task-related uses
so to make Merril’s (2007) task-centered approach viable.
From the author’s perspective, the confined environment of the laboratory is the
most suitable ba where explicit and tacit knowledge can be created and shared both by
laboratory workers and clinical laboratory diagnostic manufacturers. The task-centered
instructional strategy described by Merril (2007) fits very well in the broad scenario
comprising different levels of clinical laboratories in most sub-Saharan African countries.
The focus of Merril’s direct instruction in the framework of real world problems is on
demonstration. Clinical laboratory total testing procedures comprise a set of complex
tasks to be executed in the same environment but under different conditions that vary on
a daily basis such as irregular patients flow, absence of co-workers, critical samples,
temporary break-down of equipment, and lack of regular power supply. The taskcentered approach proposed by Merril is very effective in the case of learners that are
new to specific topics since the integration of “component knowledge and skill into
whole tasks results in higher motivation and a better ability to apply the newly acquired
skill in new situations” (p.6). This scenario of learners new to specific clinical laboratory
testing procedures is quite frequent at the lower level of the laboratory network
(Marinucci et al., 2013). The most valuable trait of Merril’s (2002) Pebble-in-the-Pond
instructional design model is the progression of tasks that learners are requested to
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perform to acquire knowledge and skills. When the process of progressive tasks takes
place in the real working context, i.e. the clinical laboratory, it is easy for learners to form
mental models and translate the information to the daily practice. The different levels of
knowledge and skills the learners need to know for performing the whole task offer
clinical laboratory diagnostic manufacturers the possibility of providing course-content
with different levels of difficulty.
However, the uses of different mobile technologies and instructional design
approaches can be effective only if an adequate system to support end users during the
learning process is established. In particular, ensuring regular, two-way communication
and feedback is a fundamental requirement for effectively supporting learners (Spronk,
2004; Alireza, 2011). In this regard, mobile phones seem the best local solution to ensure
consistent two-way communication to be included in the overall learning strategy
(Gaskell & Mills, 2004).
The Current Status
The four cases presented in the literature review on the current learning and
training offer present some common features. All the diagnostic companies use their web
portals to deliver the content of the courses. This makes mandatory for end users to have
access to a computer with a decent connection to the Internet. When video and audio are
the media of choice it is imperative to have a strong connection able to ensure smooth
play of the files. This aspect is less problematic when the delivery of the content occurs
through written medium. This is the case of the Sysmex Academy where a series of
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written documents are available for free download. The course provided by BD
Biosciences uses software able to guide the learners through all the sections of the class.
The design is fresh and the navigation very intuitive and easy. Although this is a very
good approach to promote interactivity and self-learning, the course content is very basic.
The trainings from HemoCue come in three different delivery modes but none of them
was currently available.
In two cases, namely Sysmex and HemoCue, it is explicitly indicated that the
content of the course can be delivered on-site to facilitate practical skills development
and meet end users’ needs. This blended approach is for sure more appropriate for
developing practical ability in the end users, but it seems not feasible to be implemented
in large scale, especially in emerging markets. However, the three different levels offered
by Sysmex are used to incrementally transfer knowledge among learners through online
learning only. This scaffolding approach is not clearly obvious from the websites of the
three other companies, however BD Biosciences presents their self-paced courses as
integration to their class-based training.
None of the companies seem to offer two-way communication and interaction
between end users and training provider during the course delivery. Only BD Biosciences
offers some sort of interactivity by inviting end users to provide feedback at the end of
the class with the goal of improving course content and quality. Besides, all four training
approaches include delivery through the Internet only and there are no options available
such as paper or computer based.
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Despite the fact that it is not possible to understand from the websites the process
behind the course-content development, it is very likely that they result from an internal
knowledge creation activity. While it is just an author’s assumption, the content of
Sysmex Academy and BD Biosciences courses seems to reflect end users practical skills
needs. The Biomerieux content is more likely promoting a knowledge transfer process,
while the HemoCue offer does not seem readily available.
Notwithstanding the respectable size of the four companies in terms of global
market share, it is evident that none of the current distance learning offers presented
above meets the requirements as illustrated by Ally (2008). Critical aspects such as
learners’ motivation, encouraging interaction, providing feedback and supporting the
learning process, and facilitating contextual learning, seem to be missing. Because of
their strong scientific expertise and leading role in the clinical diagnostic field, the four
companies seems to be more focused on state-of-the-art course content rather than on
impactful course design.
The overall management of knowledge across a single organization plays an
important role in generating training activities for end customers. This aspect is of
paramount importance for clinical laboratory equipment manufacturers that need to
transfer knowledge and skills as soon as their products reach the market. While the
activities available to achieve this goal are several, distance learning and e-learning offer
the unique chance of reaching more end users across different countries. However, the IT
infrastructure gaps in many emerging economies pose significant limitations to the
delivery of course content through the Internet. Alternative delivery modes should be
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explored to effectively reach the audience in both urban and rural locations. The wide
availability of smartphones among end users and the limited physical environment where
the training takes place, namely the clinical laboratory, offer a specific scenario for
innovative distance learning and e-learning approaches.
New Conceptual Model
Regardless of the delivery mode, the instructional design, and the pedagogical
approach, it is very important that course content is generated through a dual process. The
first procedure is internal to the private company where the four steps of the SECI model
follow the original pathway of the authors. The second action occurs at the same time as
the first one and it involves the individuals (i) such as the laboratory workers, the group
(g) such as the laboratory staff, and the organization (o) such as the health facility
beneficiary of the laboratory, diagnostic technology. However, even if both processes
take place in two different physical environments, Web 2.0 tools and distance learning
can effectively support the interaction of the two concentric systems.
As illustrated in quadrant one of figure 1 below, a first interaction might occur
during the socialization step of the SECI model where the sharing of tacit knowledge
takes place between individuals across both organizations. Even if this step happens at
the individual level, the private company should develop an internal structure to facilitate
this kind of interaction. It is at this stage where through informal communication that the
manufacturer can gather important information useful to tailor course content and
instructional design.
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Quadrant two shows a second kind of interaction where the knowledge
management internal to the organization and distance learning overlap during the
externalization step of the SECI model. This process should be carefully planned and
tailored on the e-learning readiness in the organization (Schreurs & Al-Huneidi, 2012).
However, for this process to effectively produce course-content for distance learning
activities directed to end customers, a clear knowledge management strategy is needed.
End users of clinical laboratory equipment can be the third parties necessary to the
externalization process, and their role as learners contributes to the conversion of tacit to
explicit knowledge. At this stage, single individuals of the manufacturing company
function as trainers of different groups of end users.
In the third quadrant of figure 1, the combination step of the SECI model takes
place separately within each organization. At customers level this might include the
refinement and elaboration of the knowledge transferred in the previous step and its
integration into laboratory standard operating procedures, quality management system,
and other documents. This process involves single end users and takes place internally to
the clinical laboratory. At company level this step comprises the development of a
repository of learning objects based also on the inputs received from end users during the
externalization phase.
In quadrant four of the conceptual model, no interaction takes place between the
two parties. The internalization process occurs internally to the whole health facility
where the use of the new diagnostic technology moves from inside the laboratory to the
clinical practice. The technical know-how and the clinical significance of the results
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generated are shared among the health facility employees by laying the foundations for
the process to start again with another clinical diagnostic technology. On a smaller scale
this process involves all the layers of the health facility and might occur through training
programs or mentoring activities.
Figure 1. The four steps of the SECI model at manufacturer (yellow) and customers (blue) levels and
the type of interaction between the two processes
Conclusion
In conclusion, the process of knowledge production and sharing with end users
through distance learning and e-learning is a great opportunity for enhancing visibility
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and market shares in emerging economies. The process should be well defined and
streamlined within the overall knowledge management strategy of the company. Distance
learning activities should be ingrained in the overall production process and their efficacy
in transferring knowledge and developing practical skills tailored to the multifaceted
scenarios. However, the success of this approach firmly depends on leaders’ vision of the
company's business mission and how distance learning can contribute in creating
competitive advantage within its business framework (Wasyluk & Berge, 2007). It is of
crucial importance that leaders create the conditions for innovation and change by
enabling employees to contribute to the vision through knowledge creation and sharing.
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