Knowledge transformation and representation : towards more informed provision and use of information

This thesis seeks to better understand the nature of, and relationships between knowledge, data and information. The context selected for this work was clinical practice in the UK National Health Service (NHS) beginning with the generation and use of clinical knowledge. The thesis undertakes a critical examination of the relationship between that knowledge and the data it produces, and the large-scale statistical data sets generated from it via a number of human, technological, systemic and mathematical processes. The statistical data sets were regarded as important because they were highly influential, being used as the basis for significant and far-reaching decisions about healthcare in the NHS. These decisions included policymaking, financial allocations, and allocations of services and other resources. This situation provided fertile ground for this research because the clinical knowledge and data were believed to be subjective to some unknown degree. The statistical data sets, however, were endowed with objective and scientific value. The thesis explores and explains this apparent contradiction.In addressing this issue, the thesis encompasses philosophical, sociological and technological concerns and develops explanatory theories grounded in data collected. Data was collected by a process of extensive qualitative field-based investigation undertaken with clinicians, and data collectors, handlers and users in their operating environments. Key concepts underpinning these theories involve the social construction of reality as a product of individual and group frames of reference; social construction of reality as a result of social arrangements for professional groups; social construction of reality as a result of the pursuance of ontological security; and lastly, the phenomena of structural contradiction and conflict. Of major relevance in this was Giddens' work (1976, 1984) on Structuration Theory, in particular in terms of exploring the effects of sociologically-based frames of reference on creation and transfer of meaning in informational terms. This work was also influential in terms of the notion of structural contradiction and conflict and its informational effects. Application of this abstract, meta-level theory to this real-world situation also led to one of the main contributions to theory. This engagement with reality enabled refinement of its underpinning model. It also demonstrated its explanatory power. This strengthens the validity of the theory and renders it more accessible to other researchers.The thesis indicates clinicians' use of information and subsequent recording of data represents a highly personalised area of professional activity. This does not subsequently translate easily into the data sets and statistical classification schemes that are in common usage in healthcare management. These findings led to conclusions which confirmed initial perceptions of statistical clinical datasets as having a tenuous connection with the clinical knowledge and events upon which they purport to be based. Drawing on evidence which describes knowledge as being situationally-dependent, the conclusions also assert that the transformation of original meaning this implies is largely due to social influences. Finally they claim that the apparent rationality of decisions made on the basis of the transformed meaning, while the result of calculative thought designed to justify related decisions, is misguided in that it has no foundation in the evidence presented. The document ends with a call for a fundamental reassessment of the types of knowledge processed routinely through systems, and of the ways in which those types are handled.