A systems approach to exploring professional performance of knowledge workers: A case study in radiology

Abstract

There is an increasing demand internationally for ‘knowledge workers’ as this workforce is required to extensively use their knowledge and skills in performing complex specialised work. Long-term sustainability of knowledge workers has been very challenging for managers and policy makers because it requires development and conservation of a well-educated, highly skilled and effective workforce. The conventional approach in dealing with workforce management challenges has been typically to apply unit level standardisation and optimisation. In this regard, job performance of knowledge workers has been studied by various researchers through individualistic and atomistic perspectives. A systems approach in dealing with complex social systems, however, implies that understanding of the system’s individual components and their interactions as a whole are both imperative. This thesis presents a novel systems approach for exploring professional performance of knowledge workers by providing new models at micro and macro levels and operationalising them within a case study. The Australian radiology workforce was considered as the domain of the study because radiologists are recognised as a classic case of knowledge workers and their work mostly comprised of application of knowledge, particularly in the correct interpretation of medical images. This research provides new insights about understanding job performance of knowledge workers from a social/professional networks perspective, along with traditional view of personal/individual characteristics. A theory-driven job performance model at micro level (i.e. performance of individuals) is presented and then tested systematically in the case study. At the same time, Australian radiology system as a whole (i.e. workforce training, supply and demand) is examined at macro/system level in order to fill the gaps in understanding managerial challenges of the workforce. In order to analyse the Australian radiology system and its components at macro level, a system dynamics modelling approach was employed to test the balance between supply and demand of radiology workforce in the long term. The results showed that traditional models in radiology are unsustainable based on growing demand for services. Accordingly, some new system level strategies should be implemented for provision of a healthy workforce in future along any unit level optimisation, such as increasing radiologists’ performance. For examining the performance of radiologists, a comprehensive research study was designed for validating and verifying the theoretical model through both qualitative and quantitative studies. The participating radiologists also independently read a test set of mammographic cases and their observer performance in detecting breast cancers was measured. According to both the qualitative and the quantitative studies, social networks play a critical role in the job performance of knowledge workers. In the quantitative study, the model proposed in this thesis could explain almost 63.5% of the variance in the observer performance; 48% for the network factors, in comparison to 15.5% for the traditional measure of radiologists’ experience. Among different factors of egocentric social networks, job performance was positively associated with degree centrality and effective size, but negatively associated with constraint and hierarchy. The practical implication of this result is that developing and maintaining effective network links in the workplace and beyond should be considered of high value for the performance of knowledge workers. Overall, this thesis lays the foundation for a new direction of research into understanding knowledge workers, their workforce system challenges and their performance through a systems perspective. This direction can be pursued by researchers in radiology as well as researchers and policy makers in other knowledge work domains with the purpose of developing and maintaining a healthy system with effective workforce.