Inter-organisational knowledge sharing to establish digital health learning ecosystems: Qualitative evaluation of a national digital health transformation programme in England

Background: The English Global Digital Exemplar (GDE) Programme is one of the first concerted efforts to create a digital health learning ecosystem across a national health service.
Objective: To explore mechanisms supporting or inhibiting exchange of inter-organisational digital transformation knowledge.
Methods: We conducted a formative qualitative evaluation of the GDE Programme. We used semi-structured interviews with clinical, technical and managerial staff, national programme managers and network leaders; non-participant observations of knowledge transfer activities through attending meetings, workshops and conferences; and documentary analysis of policy documents. Data were thematically analysed drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software to facilitate coding.
Results: We conducted 341 one-to-one and 116 group interviews, observed 86 meetings, and analysed 245 documents in 36 participating provider organisations. We also conducted 56 high-level interviews with policymakers and vendors; 84 observations of national meetings, workshops, and conferences; and analysed 80 national documents.Formal processes put in place by the GDE Programme to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective where supported by informal networking. Benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas.
Conclusions: Knowledge exchange is most effective when sustained through informal networking driven by mutual benefits of sharing knowledge, and convergence between group members in their organisational and technological setting and goals. Policy interventions to enhance incentives and reduce barriers to sharing across the ecosystem may be more productive than promoting particular knowledge transfer mechanisms.