Cultura informacional e intercambio de información en el ámbito sanitario. Estudio de un caso: el servicio de neurología del hospital La Fe de Valencia

En todo tipo de organizaciones es un denominador común la búsqueda de la competitividad como medio para sobrevivir en un mundo globalizado. Ya en el año 1994 Cornellà (1994), siguiendo a Itami (1987), consideraba que las organizaciones manejaban dos tipos de recursos: los tangibles y los intangibles. Los recursos tangibles son los que crecen y proporcionan competitividad a la organización gracias a los flujos de dinero. Se trata de recursos que son necesarios para su funcionamiento, pero no son suficientes por si mismos pues requieren un segundo tipo de recursos para alcanzar la deseada competitividad, los intangibles. Los recursos intangibles en una organización son, por ejemplo, su imagen de marca, los procesos de interacción con los consumidores o el capital intelectual acumulado por los miembros de la organización derivado de la actividad realizada en el pasado. Sin embargo, si los recursos tangibles crecen por los flujos económicos, los recursos intangibles crecen gracias a los flujos de información. La información está presente en cualquier proceso de interacción que ocurre en una organización y dista mucho de ser un fenómeno estático. Por el contrario, las personas que trabajan juntas intercambian información obtenida por diversas fuentes, la reelaboran, y la vuelven a compartir. En este sentido, los hospitales pueden considerarse organizaciones donde se requiere un uso intensivo de todo tipo de información. De tal manera ocurre esto que el contexto en el que se intercambia información está constantemente reconfigurándose, lo que hace de éste un fenómeno difícil de conocer y describir. El comportamiento informacional colaborativo y la cultura informacional en la que este se produce son aspectos del trabajo colaborativo de las organizaciones sanitarias de capital importancia, que van a determinar, de alguna manera, la consecución de los objetivos comunes de la organización. En las últimas décadas los constantes avances médicos y los cambios en la organización funcional de la sanidad han provocado modificaciones en las estructuras de la actividad de los hospitales. Para su estudio, es necesario integrar perspectivas que ofrezcan un marco de referencia teórico y metodológico que ayude a describir, pero también a comprender, cuáles son los condicionantes que intervienen en el intercambio de información. El objetivo de esta tesis fue investigar la cultura informacional y los flujos de información de un servicio clínico de un hospital de tercer nivel asistencial de la sanidad española, con una estructura funcional conformada por unidades clínicas multidisciplinares. Para ello primero se empleó el modelo information orientation para el estudio de la cultura informacional. Posteriormente se utilizó la metodología del análisis de redes sociales para estudiar los flujos de información en esa organización. Desde esta perspectiva la cultura informacional del servicio estudiado se caracterizó por una alta representación de las dimensiones integridad, intercambio, proactividad y formalidad. Estas dimensiones eran favorables para el trabajo colaborativo y el intercambio de información. Sin embargo, la falta de reconocimiento de fortalezas en las dimensiones control y transparencia podía poner en peligro dicha competitividad, al faltar información adecuada sobre los objetivos y resultados comunes de la organización, y la falta de confianza mutua que se deduce de la falta de transparencia. Por su parte, la red informacional compuesta por los informantes del servicio fue una red relativamente densa, cohesionada, pero que no obstante mostró ciertas debilidades estructurales para el trabajo colaborativo y el intercambio de información eficiente en toda la red, como la baja reciprocidad, homofilia, diversos agujeros estructurales y flujos de información verticales, jerarquizados. Las principales conclusiones del estudio fueron que, a pesar de existir una estructura de unidades clínicas multidisciplinares, los patrones de comunicación dentro del servicio de neurología seguían los patrones de la homofilia en una estructura jerarquizada. Además, pese a que las características de la cultura informacional del servicio favorecen a priori un adecuado intercambio de información, ésta no necesariamente determina que se produzca en el seno de los equipos multidisciplinares.In all types of organizations, the search for competitiveness as a means to survive in a globalized world is a common denominator. Already in 1994 Cornellà (1994), following Itami (1987), considered that organizations managed two types of resources: tangible and intangible. Tangible resources are those that grow and provide competitiveness to the organization thanks to money flows. These are resources that are necessary for their operation, but they are not sufficient by themselves because they require a second type of resources to achieve the desired competitiveness, the intangibles. The intangible resources in an organization are, for example, its brand image, the processes of interaction with consumers or the intellectual capital accumulated by the members of the organization derived from the activity carried out in the past. However, if tangible resources grow due to economic flows, intangible resources grow thanks to information flows. Information is present in any interaction process that occurs in an organization and is far from being a static phenomenon. Rather, people working together exchange information obtained from various sources, rework it, and share it again. In this sense, hospitals can be considered organizations where an intensive use of all kinds of information is required. This happens in such a way that the context in which information is exchanged is constantly being reconfigured, which makes this a difficult phenomenon to understand and describe. Collaborative informational behavior and the informational culture in which it occurs are aspects of the collaborative work of health organizations of paramount importance, which will determine, in some way, the achievement of the common objectives of the organization. In recent decades, constant medical advances and changes in the functional organization of healthcare have caused changes in the structures of hospital activity. For its study, it is necessary to integrate perspectives that offer a theoretical and methodological reference framework that helps to describe, but also to understand, what are the conditioning factors that intervene in the exchange of information. The objective of this thesis was to investigate the informational culture and information flows of a clinical service of a tertiary care hospital of Spanish health, with a functional structure made up of multidisciplinary clinical units. For this, the information orientation model was first used for the study of informational culture. Subsequently, the methodology of social network analysis was used to study the information flows in that organization. From this perspective, the informational culture of the service studied was characterized by a high representation of the integrity, exchange, proactivity and formality dimensions. These dimensions were favorable for collaborative work and information exchange. However, the lack of recognition of strengths in the control and transparency dimensions could jeopardize said competitiveness, due to the lack of adequate information on the objectives and common results of the organization, and the lack of mutual trust that is deduced from the lack of transparency. For its part, the informational network made up of informants from the service was a relatively dense, cohesive network, but which nonetheless showed certain structural weaknesses for collaborative work and efficient information exchange throughout the network, such as low reciprocity, homophily, various structural holes and vertical, hierarchical information flows. The main conclusions of the study were that, despite the existence of a structure of multidisciplinary clinical units, the communication patterns within the neurology service followed the patterns of homophily in a hierarchical structure. In addition, despite the fact that the characteristics of the informational culture of the service a priori favor an adequate exchange of information, this does not necessarily determine that it occurs within multidisciplinary teams

Culture of information and information exchange in a public hospital : a study based on the information orientation model and social network analysis

The structures of hospitals have evolved to make them centre on patients and their pathologies, with care procedures that are both interprofessional and interorganisational. This has given rise to work environments made up of teams obliged to collaborate in their problem-solving, with an essential focus on proper collaborative information behaviour (CIB). The aim was to study this behaviour in a clinical service of a hospital in relation to two aspects: information culture (IC) and the exchange of information. This entailed designing a two-part descriptive study. The first step was to administer a survey based on the information orientation model to know more about the service's IC. The second phase focussed on the exchange of information from the perspective of an analysis of social networks. The main characteristic of IC was its proactive nature, especially in the use of information to improve one's own work (mean = 4.58) and to respond to changes and new developments relating to work (mean = 4.18). The factor that least characterised IC was control, particularly in relation to knowledge of the objective of the activity itself (mean = 2.67) and the dispersion of information about hospital processes (mean = 2.64). On social networks, factors contrary to an interprofessional CIB were identified, such as homophily and low reciprocity in terms of relationships. In practice, the results identified a need to reinforce the perception of information as a resource, the proper use of which benefits job performance at both an individual and group level. A need to reinforce flows of internal hospital-related information was likewise evident. From a theoretical and methodological point of view, a useful tool is made available for diagnosing the collaborative information behaviour of an organisation and designing strategies to improve it