Zhe Zhang Assistant Professor School of Management Xi’an jiaotong University

1. The effectiveness and efficiency of knowledge transfer from the doctor to recipient: An empirical study in China after the Sichuan 5.12 earthquake Zhe Zhang Assistant Professor School of Management Xi’an jiaotong University

2. Motivation?

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4. Motivation • Nowadays about 450 million people around the world suffer from mental illnesses, with associated costs accounting for 11% of all global medical expenditures. For example, of these, about 45 million adults suffer from schizophrenia (Curlin, F. A.2007). • Furthermore, the financial crisis which exploded for nearly one year has caused enormous investor losses, while at the same time a large number of employees have to endure greater mental pressure in many countries including China. • Besides these normal phenomenon which can cause the mental disease, with the more and more natural disaster frequently happen these days, it has become another major cause for mental disease.

5. Motivation • Context: more and more natural disaster e.g. South Asian tsunami of 2004, Hurricane Katrina and the Kashmiri earthquake in 2005, the California wildfires of 2007; Earthquake in Italy (2009); in Haide (2010);in Indonesia (2010)

6. Motivation • After the natural disaster, people in the disaster area definitely have a unique traumatizing time, which will bring challenge not only to the physical conditions but also to the psychological endurance. When their lovely homeland overnight turns into a place full of debris and corpses, especially when they witness the family members’ loss with their own eyes, no wonder they will be shocked by these diabolical scenes, therefore and it’s most likely to increase the suicide rate caused by various kinds of mental disease.

7. Motivation • On May 12th, 2008, at 2:28 pm, a severe earthquake of magnitude 8.0 struck suddenly in the Sichuan province, China. The earthquake claimed the lives of almost 70,000 people, leaving 4.8 million homeless and over 15 million displaced.

8. Motivation • After Sichuan 5.12 earthquake, the mental disease is prevailing in disaster area. In order to decrease the suicide rate, Sichuan local governance with the assistant of the diverse hospitals have established “three-level network of prevention and treatment on mental disease”, which aims at disseminating the knowledge on prevention and treatment from doctors to recipients, especially finding out some pre-diagnostic symptoms.

9. Three-level network of prevention and treatment (1) common phenomenon and diagnosis on children PTSD, depression et al.; (2) the principles of drug treatment on children PTSD, depression et al.; (3) the principles of psychological treatment on children PTSD, depression et al.; (4) the principles of treatment on children common emotional and behavioral problems network-training for the professional personnel in the local mental health institutions (1) the common methods on student’s emotional ease and communications; (2) the performance of emotional, behavioral problems and some relevant risk factors after the disaster; (3) early identifying children emotional and behavioral problems after the disaster; (4) the treatment procedure after discovering the student’s mental health problem. network-training for the mental health instructors in the school network-training for the teachers in the school (primary school and middle school)

10. Some relevant activities after the 5.12 earthquake 10

11. Motivation • How to disseminate the knowledge of the prevention and treatment on mental disease from the doctors to the recipient more effectively and more efficiency deserves us to focus on.

12. Motivation • This study examines the impact of knowledge characteristics, the network status of the doctor, the network status of the hospital in which the doctor is affiliated, and the relationship quality between doctor and recipient on the effectiveness and efficiency of knowledge transfer from the doctor to patients.

13. Framework

14. Hypothesis • Knowledge characteristics and doctor-recipient relationship quality • knowledge on “psychiatric prevention and treatment”: value and rareness (Barney,1991) • “valuable” if it enables the recipient to formula a viable approach to prevent the disease in a more effective and efficient manner. • “rare” when it is possessed by a limited number of doctors • H1: Perceived value and rareness associated with knowledge being transferred from doctor to the recipient will be positively related to the relationship quality between doctor and the recipient.

15. Hypothesis • Network status and knowledge transfer • After the earthquake, the low status organization is usually proximate to the first-line disastrous area; therefore the proximity makes it possible to dispatch the numerous psychiatrists to provide the accessible knowledge on “psychiatric prevention and treatment”. • Especially after the earthquake, the speed of mobilizing resources is one of the most important factors for management in the context of crisis, certainly for the knowledge transfer process at that urgent time. • H2: the low-status hospital with which doctor is affiliated is positively associated with the speed of knowledge transferred from doctor to recipient.

16. Hypothesis Doctors who belong to high-status professional groups is deemed to master more integrated knowledge, correspondingly is taken as more authoritative than the low-status doctor. • What’s more, a large number of high-status doctors are not only doctors at the hospital, but also have a title of professor or associate professor, most of them lead a group of students who are pursuing master degrees or ph.d. Therefore, it’s no wonder that the high-status doctor always have more experience not only to consult with patient but also impart knowledge. • H3: the high-status doctor is positively associated with the comprehension of knowledge transferred from doctor to the recipient.

17. hypothesis • Doctor-recipient relationship quality refers to the extent to which the relationship between the doctor and recipient is close, strong, and based on mutual trust. • Both Dhanaraj et al. (2004) and Lane et al., (2001) have suggested that trusting relationship facilitate knowledge transfer. • the doctor-recipient relationship quality can also be expected to have a positive effect on the speed of knowledge transfer between doctor and recipient. Just as Reagans and McEvily (2003) have found that the strength of ties between two individuals impact the ease of knowledge transfer, with close ties resulting in less time and effort being spent on the transfer process • H4: The doctor-recipient relationship quality mediates the relationship between knowledge characteristics and the comprehension and speed of the knowledge transferred between doctor and recipient.

18. Methods • We collected data using a survey of crisis management in China’s healthcare system after the 5.12 Wenchuan earthquakes. • The main survey was administered from December 2008 to April 2009.

19. Method • A survey team distributed survey packages to participating hospitals, such as the Huaxi hospital, other hospitals in the Huaxi network, other regional hospitals, affiliated healthcare facilities in Sichuan province and some hospitals in other badly-hit provinces.

20. Methods • These doctors mainly included departments of neurology. The only group that exhibited a within-group response rate and mission data of lower than 50% was eliminated from our sample. There are A and B two packages of questionnaire, in which A is for doctors to fill in, B needs the recipient to fill in. • After eliminating the incomplete questionnaires, the final sample consisted of 146 groups with 146 doctor and the correspondingly recipient.

21. Scales

22. Method • We used factor analysis to test the reliability and validity of the scales. Structural equation modeling (SEM) with latent constructs was used to test the four hypotheses. The LISREL program (Jöreskog & Sörbom, 2001) was used to perform SEM analyses. The fit of the measurement model was assessed followed by the test of the structural model (Anderson & Gerbing1988; Wu, Tsui & Kiniki, 2009).

23. Result

24. Limitation • Retrospective bias • We collected data retrospectively because of the particular context for this research. In the context of the earthquake, every participant in our research was part of the backbone of the rescue mission. Because this natural disaster was on such a large scale, we had to wait for quite a long period of time before conducting the research.

25. Limitation • collecting the data retrospectively allowed for a more focused data-gathering process (Poole et al., 2000). At the same time, unconscious respondent bias may arise in retrospective studies, leading to confusion about cause-and-effect relationships (Leonard-Barton, 1990).

26. Conclusion • Based on a sample of 146 doctor-recipient pairs from 52 hospitals in diverse districts of China, this study finds that the high-status doctor is affiliated positively impact the effectiveness of knowledge transfer. In addition, low-status hospital was found to have a positive effect on knowledge transfer efficiency. In particular, results highlight the strong positive impact that the quality of relationship between the doctor and the recipient has on both the efficiency and effectiveness of knowledge transfer.

27. 2009-2011 reform plan • The country's basic public health services • disease prevention • maternal and children health • health education • occupational health • prevention and treatment of mental illness

28. Thank you !