Thesis (Ph. D.)--State University of New York at Binghamton, School of Management, 2008. / Includes bibliographical references.

This thesis empirically investigates how well the Nigerian National Petroleum Corporation (NNPC) ensures value for money (VfM) in its exploitation of Nigeria’s oil resources. This focus on VfM distinguishes the study from other researches carried out on the performance of national oil companies (NOCs) where the common approach in the literature has been to assess performance using the metrics applicable to private oil companies. The rationale for the new approach is that the NNPC is a quasi-public sector organisation and thus its performance should be measured in the same way as that of public sector bodies and state owned enterprises (SOEs). Informed opinions on NNPC’s management roles in Nigeria’s oil and gas upstream sector were sought from a range of relevant experts in twelve stakeholder groups involved in oil and gas upstream operations. Data were collected through the use of questionnaire and interview surveys, and further subjected to statistical analysis to determine and assess significant differences in views between respondent groups. The empirical results obtained from the questionnaires were used to draw a conclusion on the hypotheses formulated for the study. Furthermore, the findings of the interview survey were used to validate the conclusions drawn. The study revealed that the NNPC was perceived to be deficient in keeping its mandate of adding value to Nigeria’s hydrocarbon resources. In specific terms, the respondents were of the view that NNPC has not been able to ensure VfM in its operations because of defects in its organisational structure, administrative system, and accountability. External factors such as political interference, instability and an inappropriate legal framework against which NNPC operates have also been perceived to impede the corporation’s performance. The main conclusions were: firstly, it is argued that the use of conventional private sector metrics to evaluate the performance of NOCs makes it difficult to form an appropriate view on their performance. Secondly, NOCs with numerous conflicting roles as is the case with NNPC are unlikely to achieve satisfactory performance. Thirdly, the NNPC lacks the capability required to ensure multinational oil companies’ (MOC) conformity with operational provisions and best practice. Finally, the thesis concludes that establishing a standardised performance/benchmarking framework is an essential requirement to ensure value addition, VfM and accountability in Nigeria’s oil and gas operations.

Following the studies of technology trajectories, Christiansen (1997) coined the concept of disruptive innovation to shed more light on the pattern of discontinuous innovations which were introducing new performance values to the market and mostly led to create a new market. Following his studies there have been a huge amount of scholars who have tried to elucidate the concept of disruptive innovations from different points of views. Among all of these studies, there are few researches about the dynamic of disruptive innovations diffusion in the market while most of the studies have focused on the concept itself. According to Porter (2008) the dynamic of market competition has been totally changed over the past decade and survivance of incumbents in the market mostly depends on their capability to innovate disruptively and keep their dominancy by radical or incremental improvements. Considering the desire of incumbents to set a dominant position in today’s fast growing markets, getting the ultimate benefits of disruptive innovations has become a disputable issue. Therefore, focusing on the dynamic of disruptive innovations, this research tries to elucidate the way that market leaders take an unknown potential disruptive innovation out of its dark corner during its infancy time, raise it and disrupt the mainstream market relying on it to establish a new market. Focusing on the dynamic of innovation diffusion, this research has chosen the high-tech medical market of Iran as the main target of empirical field work. Novelty of this concept in medical markets and also appropriateness of invasive cardiovascular devices business in terms of great amount of disruptive innovation, make this case study appropriate for the purpose of this research. Therefore conducting a longitude case study of Iranian invasive cardiovascular market during the past 10 years, this research conducts 30 semi-structured interviews with the key decision makers of the four main incumbents of Iranian invasive cardiovascular market about launching new innovations including: Johnson and Johnson (Cordis), Abbott Laboratories, Boston Scientific and Medtronic. The findings of these interviews are supported by the results of archival researches for more validity and reliability. Finally these findings will get compared with the conceptual framework of research in the discussion chapter to modify the existing literatures and in some cases add some new theoretical notions to them. The main contribution of this research is to identify the accelerating factors of disruptive innovation diffusion from, strategic, technological and cultural points of views. These findings can help practitioners to accelerate the diffusion rate of their disruptive innovations to disrupt the market earlier than the others and set their dominant position in the market as a market leader. Also it will provide an opportunity for the other scholars to build on more about the concept of disruptive innovation diffusion.

The initial idea for this research is based on the gap that I found in my company performance and specifically in the process of value offering and the relationship with customers. The company has recently faced the challenges of a loss of market share and competitive advantage. The aim of this study is to provide a validated value offering constructs for the company. That is, knowing the customers’ needs, value and preferences better; identifying what kind of value the customers are looking for and improving the value offerings of the company in order to raise customers´ satisfaction. Understanding the priority of value offering elements from customers’ perspective, the nature of customer satisfaction and the relationship between the elements of value offering and customers´ satisfaction are the main objectives. The relevant literature and research related to value offering including its elements, value, perceived value and customer satisfaction are reviewed comprehensively. The methodology used is a case study. Both quantitative and qualitative methods are used for collecting and analysing the data. In qualitative phase, 16 customers were selected for in-depth interviews and for quantitative phase 268 customers who all are dentists responded a survey made up of 24 scales. The result showed that the highest significant element is Price value and also it was revealed in which important parts related to value offering and customer satisfaction the company is performing poorly.

The master thesis deals with business performance and various approaches to its measurement with the emphasis on value management. The aim is to analyze the value creation and the performance of the company Kronomech, spol. s r.o. Then identify strategic factors affecting the value of the company, including the proposal of measures for its growth. The theoretical part focuses on indicators and models to allow assessment of business performance. These indicators are then applied in the practical part on the selected company. Attention is focused on the indicator of economic value added and the models investigating the financial position of the company. The overall economic performance of the company is evaluated, including consideration of nonfinancial indicators. The final part contains formulated measures that will lead to the consolidation of the financial health and to improve the performance of the selected company.

Purpose/ Background The key resource for value creation in ambulatory healthcare is knowledge. Providers of ambulatory care are faced with knowledge-related challenges: Increasingly complex disease patterns and rapid medical innovation overwhelm their capacity to identify, generate, integrate, modify, diffuse and apply relevant knowledge. This results in reduced quality of care. Nevertheless, knowledge-based value creation has not been widely explored in ambulatory healthcare. Several research gaps explain: There are few publications regarding tools and methods for the management of knowledge resources in this context. Furthermore, the causal links between knowledge and organizational outcomes has not been theorized. A third major gap in the literature is the non-existence of frameworks for measuring knowledge-induced ambulatory healthcare performance. Against this backdrop, this dissertation attempts to answer the following overarching question: How can knowledge-based value creation be managed and measured in ambulatory healthcare? Design/ Methodology/ Approach This cumulative dissertation adopts a mixed-methods approach, i.e., each of the four included publications adopts a methodological approach appropriate to its topic and research question. The first publication narratively reviews major developments in Intellectual Capital (IC) and Knowledge Management theory. It benchmarks the new industry standard on Knowledge Management Systems (ISO 30401) against the previous literature by means of document analysis. Thereby it summarizes the state of research and practice regarding knowledge-based value creation. The second publication takes the form of a systematic literature review. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, it summarizes the literature on Knowledge Management and performance in ambulatory healthcare. It compiles an overview of Knowledge Management practices which have been studied in the literature. Furthermore, it lists the indicators used to measure the impact of Knowledge Management on ambulatory healthcare performance and assesses their usefulness for further research and practice. The third publication explores the Knowledge Management-performance relationship by means of qualitative data analysis. Based on interviews with stakeholders from the ambulatory healthcare context, a toolbox of human-centered Knowledge Management methods and technical Knowledge Management tools for ambulatory healthcare is compiled. A conceptual model of the causal links between knowledge and organizational value creation is derived. The fourth and final publication uses social network analysis to measure Relational Capital in referrer networks of medical specialists in ambulatory settings. Using inferential statistics, it correlates Relational Capital with the economic performance of healthcare providers.   Findings The first publication shows that the “ISO 30401:2018 Knowledge Management Systems” standard successfully integrates the broad and heterogenous extant literature on Intellectual Capital and Knowledge Management. The standard creates a common language for this research field and provides guidelines for Knowledge Management Systems across geographical, industry and organizational settings. As it is intentionally neutral with regards to concrete Knowledge Management tools and methods, the challenge lies in the implementation of the standard in practice. The second publication is a systematic literature review on Knowledge Management and its effects on the performance of ambulatory healthcare providers. It reveals that the previous literature is narrowly focused on 6 types of Knowledge Management practices, namely Electronic Health Records, Health Information Systems, Clinical Decision Support Systems, Trainings, Communities of Practice and bundles of firm-specific Knowledge Management initiatives (“multi-faceted interventions”). In previous publications, these tools and methods were mostly studied in relation to healthcare quality, while other outcomes like financial performance, staff engagement and patient satisfaction were neglected. The third publication, an interview-based conceptual study, paints a different picture than the literature review. Practitioners use a much broader range of Knowledge Management initiatives than those studied in the literature. Specifically, self-learning tools such as apps and podcasts as well as immersive training sessions are used by ambulatory healthcare providers. Also, technical gadgets for speech recognition and automated data processing are used. Sector stakeholders also relate Knowledge Management initiatives to a much wider set of outcome dimensions than the academic literature. Financial performance, staff engagement and client (patient/ referrer) satisfaction were named as distal outcomes. According to the interviewees in the study, Knowledge Management initiatives have direct causal connections with these outcomes as well as indirect connections mediated by quality and efficiency. The fourth publication shows that Relational Capital in social-professional networks of medical specialists can be measured by social network metrics (degree, density, relative betweenness centrality, referrer concentration). Furthermore, empirical support for the relationship between the Relational Capital and economic performance of medical specialist offices is provided. Originality/ Value In summary, this thesis makes three key contributions to research: Firstly, it provides an overview of human-centered Knowledge Management methods and technical Knowledge Management tools for the ambulatory healthcare context. Secondly, it sheds light on the causal links between knowledge resources and value/performance delivered by ambulatory healthcare providers. Thirdly, it develops a measurement framework for Relational Capital. Finally, it points out a range of research questions worth exploring.:1 Introduction 1 2 Theoretical Premises 5 2.1 Definitions 5 2.1.1 Ambulatory Healthcare 5 2.1.2 Value in Ambulatory Healthcare 9 2.1.3 Knowledge 11 2.1.4 Knowledge Management 12 2.1.5 Intellectual Capital 18 2.2 The Resource-based View of the Firm 21 2.2.1 Historic Development 21 2.2.2 Key Criticisms 24 2.2.3 Applicability of the Resource-based View to Healthcare 24 2.3 Intellectual Capital Theory 27 2.3.1 Historical Development of Intellectual Capital Theory 27 2.3.2 Intellectual Capital Theory in (Ambulatory) Healthcare 37 2.3.3 Criteria for Constructing and Assessing Intellectual Capital Measurement and Management Frameworks 39 2.4 Knowledge Management Theory 41 2.4.1 Development of Knowledge Management Theory 41 2.4.2 Knowledge Management Theory in (Ambulatory) Healthcare 50 2.4.3 Criteria for Constructing and Assessing Knowledge Management and Measurement Frameworks 51 3 Methodology and Data 53 3.1 Thesis: Mixed Methods Approach 53 3.2 Methodology Publication 1: Narrative Review and Document Analysis 55 3.2.1 Methodological Considerations 55 3.2.2 Data and Analyses 56 3.2.3 Trustworthiness 56 3.2.4 Methodological Issues 56 3.3 Methodology Publication 2: Structured Literature Review 57 3.3.1 Methodological Considerations 57 3.3.2 Sampling and Data Collection 58 3.3.3 Trustworthiness 61 3.3.4 Methodological Issues 61 3.4 Methodology Publication 3: Interview-based Qualitative Data Analysis 63 3.4.1 Methodological Considerations 63 3.4.2 Interview Guide Development 63 3.4.3 Sampling and Data Collection 64 3.4.4 Analyses 66 3.4.5 Trustworthiness 67 3.4.6 Methodological Issues 67 3.5 Methodology Publication 4: Social Network Analysis and Inferential Statistics 69 3.5.1 Methodological Considerations 69 3.5.2 Metric Choice 69 3.5.3 Network Construction 73 3.5.4 Regression Methodology 73 3.5.5 Model Specification 76 3.5.6 Database and Software 82 3.5.7 Reliability and Validity 82 3.5.8 Methodological Issues 82 4 Publication 1: The ISO 30401 Knowledge Management Systems Standard – A New Framework for Value Creation and Research? 83 4.1 Abstract 83 4.1.1 Purpose 83 4.1.2 Design/ Methodology/ Approach 83 4.1.3 Findings 83 4.1.4 Originality/ Value 83 4.2 Introduction 84 4.3 Theoretical Background 85 4.3.1 Roots of Knowledge Management Theory 85 4.3.2 Knowledge and Value – the Resource-based View (before 1991) 86 4.3.3 Theory Development in the 1990s 86 4.3.4 Theoretical Diversification and Empirical Testing in the 2000s 88 4.3.5 Consolidation in the 2010s 88 4.3.6 Approaches to the ISO 30401 89 4.4 Structure and Content of the ISO 30401 – Knowledge Management Systems Standard 90 4.4.1 Structure of the ISO 30401 90 4.4.2 Knowledge Management System Requirements According to ISO 30401 90 4.4.3 Features of the Organizational Context Supporting the Knowledge Management System 93 4.4.4 Non-requirement Statements 93 4.5 Looking Back: Benchmarking the ISO 30401 Against the Literature 94 4.5.1 Nature of Knowledge Management 94 4.5.2 Knowledge Management Practices 95 4.5.3 Knowledge Management Enablers 97 4.5.4 Knowledge and Value Creation 99 4.6 Looking Forward: Maximizing Knowledge-based Value Creation 100 4.6.1 Operationalize the ISO 30401 Based on Empirical Evidence 100 4.6.2 Leverage Effects of Standardization on the Organization 101 4.6.3 Consider Market Forces 101 4.7 Conclusions 102 4.7.1 Synthesis of Findings 102 4.7.2 Contribution and Limitations 102 5 Publication 2: Knowledge Management as a Driver of Performance in Ambulatory Healthcare – a Systematic Literature Review Through an Intellectual Capital Lens 104 5.1 Abstract 104 5.1.1 Purpose 104 5.1.2 Design/ Methodology/ Approach 104 5.1.3 Findings 104 5.1.4 Originality/ Value 104 5.2 Introduction 105 5.3 Methods 106 5.3.1 Data Sources and Search Strategy 106 5.3.2 Quality Assessment Strategy 107 5.3.3 Inclusion and Exclusion Criteria 107 5.3.4 Data Extraction Methods 108 5.4 Findings 108 5.4.1 Search Results 108 5.4.2 Types of Knowledge Management Initiatives and Knowledge Management Impact on Intellectual Capital 109 5.4.3 Performance Dimensions, Indicators and Impact 133 5.4.4 Relevance, Validity and Feasibility of Indicators 134 5.5 Discussion 135 5.5.1 What Knowledge Management initiatives have been used by ambulatory healthcare providers and how do they influence Intellectual Capital? 135 5.5.2 How has Knowledge Management-induced performance been operationalized in ambulatory healthcare and what impact of Knowledge Management on performance has been observed? 136 5.5.3 How suitable are the indicators used in the literature for further research on Knowledge Management, Intellectual Capital and performance in ambulatory healthcare settings? 137 5.5.4 Implications for Research 138 5.5.5 Implications for Practice 139 5.5.6 Limitations 139 6 Publication 3: Developing a Conceptual Model for Knowledge Management and Organizational Success in Ambulatory Healthcare 140 6.1 Abstract 140 6.1.1 Purpose 140 6.1.2 Design/ Methodology/ Approach 140 6.1.3 Findings 140 6.1.4 Originality/ value 140 6.2 Introduction 141 6.3 Related Literature 142 6.3.1 Definition: Fluid Nature of Knowledge 142 6.3.2 Definition: Business Process-Oriented Knowledge Management 142 6.3.3 Knowledge Management in Ambulatory Healthcare 143 6.4 Methodology 144 6.4.1 Sample: Two Sets of Semi-structured Interviews 144 6.4.2 Method: Qualitative Content Analysis (“Coding”) 145 6.5 Findings 145 6.5.1 Process-oriented Taxonomy of Knowledge Management Methods and Tools for Ambulatory Healthcare 145 6.5.2 Conceptual Model of Knowledge Management-induced Ambulatory Healthcare Performance 149 6.6 Discussion 154 6.7 Conclusion 156 7 Publication 4: Relational Capital in Referrer Networks of Medical Specialists in Office Settings 158 7.1 Abstract 158 7.1.1 Purpose 158 7.1.2 Design/ Methodology/ Approach 158 7.1.3 Findings 158 7.1.4 Originality 158 7.2 Introduction 159 7.3 Literature-based Hypothesis Development and Variable Selection 161 7.3.1 Dependent Variable: Economic Performance 162 7.3.2 Independent Variables: Network Characteristics 162 7.3.3 Control Variables: Characteristics of the Organization 166 7.4 Methods 167 7.4.1 Data Source 167 7.4.2 Constructing Medical Specialists’ Networks 167 7.4.3 Statistical Analyses 168 7.5 Findings 168 7.5.1 Sample Characteristics and Descriptive Statistics 168 7.5.2 Correlation of Network Characteristics with Practice Performance 170 7.6 Discussion 173 7.7 Conclusion 174 7.7.1 Contributions to the Literature 174 7.7.2 Implications for Practice 174 7.7.3 Limitations 175 7.7.4 Opportunities for Future Research 176 8 Discussion and Conclusion 177 8.1 Summary of the Results of the Thesis 177 8.2 Contributions to Research 178 8.2.1 Topic 1: Management of Knowledge Resources 178 8.2.2 Topic 2: Knowledge and Value Creation 179 8.2.3 Topic 3: Knowledge (Performance) Measurement 180 8.3 Implications for Practice 181 8.4 Limitations 183 8.5 Opportunities for Future Research 183 8.6 Conclusion 185 9 Appendix I: Questionnaire for Publication 3 (Physician Version) 186 10 Appendix II: Code Counts from the Second Interview Cycle (Publication 3) 192 11 Publication bibliography 198