Self-organization and absorptive capacity

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Self-organization and absorptive capacity

The effects of introducing a new logo in a physiotherapists practice

By Youri van Dijk Student number: 2189003

University of Groningen

Business Administration – Strategic Innovation Management

Faculty of Economics and Business

Date: 18 January 2016

Word count: 15.260

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Abstract

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Table of figures and tables

Figure 1. 'Stairway to Heaven' (Nijs, 2013) ... 11

Figure 2. Model of ACAP (Zahra & George, 2002) ... 13

Figure 3. Idea for new logo ... 18

Figure 4. IT lifecycle (www.net-care.nl) ... 19

Table 1. order-creating process (Lichtenstein, 2008) ... 10

Table 2. Step-by-step procedure ... 17

Table 3. Different roles interviewees. ... 21

Table 4. Number of colleagues and general practitioners mentioned as sources and type of networks per interviewee ... 24

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1. Introduction

The environment is becoming more complex day by day, through the interdependence of everyone. The complexity of this turns out to be overwhelming at times (Montuori, 2011). In these complex circumstances, linear logic is not sufficient anymore, and new logic is needed to describe the dynamics of an organization dealing with these circumstances. Complexity theory is acknowledging the fact that we are not dealing with linear logic, but rather with ‘emergent properties’ (Byrne, 1998).

A manner for an organization to cope better with the complex environment is changing its linear logic of the creation of goods in value chains with the customer as a receiver, to a more unified orientation which focuses on co-creation together with customers (Vargo & Lusch, 2004). The idea that actors are separately competing to gain profits, is insufficient in a world where organizations are embedded in networks of social, professional and exchange relationships with other organizations (Gulati, 1998).

These rationales have big consequences for the way in which organizations deal with problems. Because of the growing uncertainty, the normal logic of mechanistic, solution oriented logic of predictability and linear causality executed through top-down command and control does not work anymore (Nijs, 2013). Organizations need to find new ways to deal with complex problems. Nijs (2013) has designed a conceptual model, called the ‘Stairway to Heaven’, that is designed with the intent to effectuate organization emergence at the hand of self-organization, by a narrative design. This complex model has the intention to deal with complex problems.

In this model all steps and dynamics (of dissipative structures) are integrated that lead from a strategic design towards organizational emergence in the envisioned strategic direction. This model exhibits the concept of ‘Imagineering’, a design approach that tries to evoke the effect of ‘rippling through and emerging into something big’, called ‘the butterfly effect’ (Nijs, 2013). This butterfly effect is based on the example that something which is perceived to be quite small, like the flapping of a butterfly’s wings can lead to dramatic changes in the behavior of the system (Hilborn, 2004). To change the perspective of an organization, from the industrial orientation to an orientation of co-creation within networks, it first has to redesign its business conception. This design method of Imagineering is used with help of a narrative design to change the mind-set of the stakeholders. Through the actions of individuals leading to collective creativity it is the intent to achieve an emerging organization: an organization that is able to function well in a more complex and open context (Nijs, 2013). By the hand of Imagineering as a design approach, it is the intention to strategically trigger and create collective creativity to realize organizational emergence to cope with complex problems (Nijs, 2013).

The model of ‘Stairway to Heaven’ has been tested and found to be effective in multiple cases, including the city of Antwerp, where the strategic direction for a more open and tolerant city was chosen and Veritas, where the strategic direction was towards more creativity and initiatives (Nijs, 2013). In other cases it was less effective, like in the case of the city of Mechelen, where people showed their negative attitude towards the new logo on Facebook (Nijs, 2013).

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6 interactions with these customers. Literature studies show that users are an important source of innovation (Bogers, Afuah, & Bastian, 2010). It is shown that customer co-creation has a positive effect on customer acceptance and learning success, which leads to market and financial success (Mahr, Lievens & Blazevic, 2014).

Besides customers as innovators, also entities like competitors, suppliers and government-funded organizations are important sources of innovation. Organizations that have a network of innovators that leverage knowledge from different sources are the most powerful agents of technological advance (Rothwell, 1972; Smith-Doerr, Owen-Smith, Koput, & Powell, 1999). Therefore, it is important for an organization to make use of external knowledge.

The model ‘Stairway to Heaven’ is designed to effectuate an emerging organization that builds upon the co-creation with many stakeholders. However, without sufficient internal knowledge related to the new available knowledge, an organization will not be able to make use of this external knowledge.

Organizations that possess relevant prior knowledge are expected to better understand external knowledge, with the result of the generation of new ideas and the development of new products (Tsai, 2001). This capability is called the absorptive capacity, which is defined as: ”a set of organizational routines and processes by which firms acquire, assimilate, transform, and exploit knowledge to produce a dynamic organizational capability” (Zahra & George, 2002). Therefore, if this dynamic capability is more developed in an organization, it is better able to absorb external knowledge and create value together with customers and other stakeholders.

Organizational units are embedded in a network coordinated through processes of knowledge transfer and resource sharing (Galbraith, 1977; Gresov & Stephens, 1993). Organizational units therefore need to possess the capacity to absorb inputs in order to generate outputs (Tsai, 2001). These inputs could be education or training, but also information gained from other stakeholders. In this paper, a physiotherapist practice is used for a case study. For physiotherapists, the absorption of their education and training helps them to perform better in their way to treat patients.

The physiotherapist practices in the Netherlands have to deal with a dynamic and complex environment. Through the creation of plus-practices by insurance companies, which are practices with a higher quality because certain criteria are satisfied, and through new challenges in the medical sector, the environment is transforming and therefore the practices should adjust to these processes. The basic task of physiotherapists to treat people and give them advice is not sufficient anymore, because of the influence of health insurance companies and because on the focus on cost control.1 If practices want to survive in this dynamic environment, they have to change their way of working and therefore a new logic is needed. However, there are conflicting thoughts of physiotherapists. On the one hand, the basic task of physiotherapists is the care of patients. But on the other hand, they are obliged to do more obliged tasks, like spending a lot of administrative and side-tasks. These conflicting thoughts make it complex to change for practices. The narrative design as described in the model ‘Stairway to Heaven’ is used with the intent to create an emerging organization by self-organization. It is planned to achieve an organization that is capable of surviving in this dynamic and complex environment.

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7 In this paper, an idea for a new logo is designed, according to the concept ‘Stairway to Heaven’ to evoke the process of self-organization to cope with this complexity. The influence of this process on the absorptive capacity of the organization will be investigated. The narrative design, in the form of a logo, is suggested to be an activation trigger for the individuals in the organization. It is proposed that an activation trigger can influence the Potential Absorptive Capacity (PACAP) of an organization (Zahra & George, 2002). Thereby through the many interactions with stakeholders and through the individual actions leading to collective creativity it is assumed that an organization enhances its absorptive capacity, and consequently it will be more effective in using external knowledge for its own activities.

An example where the narrative design has led to self-organization is the city of Amsterdam. In this city a new logo is designed with letters of 2 meters high and 23.5 meters wide: “I Amsterdam. The intention of this logo is for people from Amsterdam to identify with the city and it also symbolizes the welcoming cheer of Amsterdam - that Amsterdam is for everyone. 2

This logo has been successful, because the letters themselves have become a touristic attraction. 3 Thereby, there are many new initiatives of, among others, the airport Schiphol and souvenir stores to associate with this new logo. 4 This logo has been introduced in 2004. Since then, the number of stays of tourists in Amsterdam has been increased from a little bit less than 8 million in 2004 to more than 12.5 million stays in 2014. Also, the number of hotels has been increased from 338 in 2004 to 421 in 2014.5

The logo has been a successful marketing tool, which has started to lead its own life. Nowadays, there is one store that sells exclusively souvenirs with I Amsterdam and there are two other logos, one at Schiphol and one travelling around in Amsterdam. Also, in the Amsterdam museum the logo is displayed in a small format. Further, this logo is making its appearance at fairs, festivals and fashion shows. All these initiatives are an innovative way of applying new ideas, related to the logo.

This example shows that the self-organization leads to a lot of interactions causing new initiatives, a process which is called emergence. It is assumed that this leads to a higher absorptive capacity, through which the city can absorb and use the external knowledge even better, when this process is continuing.

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8 ideas and solve problems (Montuori, 2011). The complexity of absorptive capacity is not just the result of individual routines, but also from complementarities between different routines (Narduzzo, Rocco & Warglien, 2001). Through the self-organization by the many interactions, it is proposed that the absorptive capacity will be increased. In this research a case study will be performed to investigate this relationship. According to Volberda, Foss & Lyles (2010) there is a gap in the literature to clarify how channels of communication implied by networks impact absorptive capacity. Therefore, the research question of this study is:

How does the process of self-organization (emergence) through interactions, evoked by a narrative design influence the absorptive capacity of individuals?

This study is contributing to the emerging model of ‘Stairway to Heaven’. By making a connection from the theory used in this model to the established concept of absorptive capacity, this study is creating some new perspectives for this model. Thereby, this study amplifies the literature of the building of absorptive capacity. By gaining a better understanding of the mechanisms of the influences of absorptive capacity, this study possesses new insights about the process of the creation of absorptive capacity.

For managers the findings of this study are important to gain a better understanding of the process of innovation. By, creating self-organization, which increases the absorptive capacity, the innovativeness will also be increased. Since, innovation is a topic that is gaining an increasing importance nowadays; this study is providing some valuable insights for managers. Thereby, innovation is an important determinant of societal economic growth and employment (Ahlstrom, 2010).

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2. Literature review

In this part, first, the emerging organization, as mentioned in the model ‘Stairway to Heaven’ will be explained. After that, the concept of absorptive capacity will be clarified.

2.1 Self-Organization

Complexity theory attempts to predict ‘the big consequences of little things’ (Nijs, 2013). In the model ‘Stairway to Heaven’ the narrative design is perceived as the little thing that evokes big consequences. Complexity theory can be divided by three different dimensions, which are algorithmic complexity, deterministic complexity and aggregate complexity (Manson, 2001).

Algorithmic complexity contends that: “the complexity of a system lies in the difficulty faced in describing system characteristics”. Deterministic complexity deals with chaos theory and catastrophe theory, which posit that: “the interaction of two or three key variables can create largely stable systems prone to sudden discontinuities”. Aggregate complexity concerns how: “individual elements work in concert to create systems with complex behavior” (Manson, 2001). The model ‘Stairway to Heaven’ deals with the aggregate complexity, because it tries to explain the organizational emergence originating from the narrative design.

Zimmerman & Glouberman (2002) made a distinction between simple, complicated and complex problems. Simple and complicated problems can be solved by using a specific approach and there is a high degree of certainty of outcome. The difference is that for complicated problems a higher level of expertise is needed than for simple problems. However, complex problems have a limited appropriability of formulas, each case is unique and there is an uncertainty of outcomes (Zimmerman & Glouberman, 2002). In this case, there is not one best way to solve the problem and therefore the process cannot be planned linearly. By the interactions among components it is believed that these complex problems can be solved in a more efficient way. The study of Nijs (2013) evaluates whether the design approach called Imagineering can evoke these interactions through self-organization and consequently an emerging organization.

The term Imagineering came into existence during World War II. The lightweight metals company Alcoa understood that it had to become innovative to have the same amount of production as it had in the war time. The company defined Imagineering as: “letting your imagination soar, and then engineering it down to earth” (Kuiper & Smit, 2014). The intent of this was not just to inspire engineers within the company, but also to stimulate the external communication to the company (Kuiper & Smit, 2014). It is a method whereby a narrative (like a logo or presentation), is designed with the strategic intent to change thinking, acting and communicating collectively in a strategically envisioned direction (Nijs, 2013). The narrative design could be perceived as an activation trigger for individuals to change their way of thinking in a certain direction.

The ‘high concept’, which is a short narrative, functions as an adaptive tension in triggering emergence in human systems by evoking collective creativity (Nijs, 2013). The adaptive tension design is defined as:

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10 reason for why nascent entrepreneurs start organizing” (Lichtenstein, Carter, Dooley & Gartner, 2007).

Therefore, the narrative design should lead to a more emergent organization. This logic is based on the work of Nobel Prize winner Ilya Prigogine for his Dissipative Structures Theory of order creation. This theory shows that we do not live in a world of linear systems, but in a more complex world where new states of being will emerge by transforming itself (Nijs, 2013). Consequently, emergence results from the interactions among components (Lansing & Kremer, 1993). Structures will spontaneously emerge when a system is pushed to a far-from-equilibrium state (Lichtenstein, 2008). In table 1 the steps for this order-creating process are described:

1. Pushing the system into a far-from-equilibrium state

2. “Fluctuations” or “perturbations” that experiment with dissipating more energy through the system, one of which gets amplified through a non-linear, positive feedback loop

3. A “nucleation” process takes place whereby the initial seed of order gets instituted throughout the system, re-organizing the components into macro structures

4. This new order is stabilized. It has the capacity dissipate orders-of-magnitude more energy through the system

Table 1. order-creating process (Lichtenstein, 2008)

“Emergence refers to the arising of novel and coherent structures, patterns, and properties during the process of self-organization in complex systems” (Goldstein, 1999). Emergent phenomena have radical novelty, are coherent, are on global or macro level, are dynamical and are ostensive (Goldstein, 1999). As mentioned previously, this phenomenon is tried to be evoked in organizations in the model ‘Stairway to Heaven’ with the design approach of Imagineering.

The emerging organization creates new opportunities in the way of how value is created. It becomes clear that businesses have to change the way in which they perceive the value created from a value chain to a value co-creation. While in the industrial view customers as consumers destroy the value created by producers, in the alternative one, value is created with different stakeholders in the value chain cooperatively (Ramirez, 1999).

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Figure 1. 'Stairway to Heaven' (Nijs, 2013)

To conclude, the aim of the model ‘Stairway to Heaven’ is to create an emerging organization, at which the value is co-created with many stakeholders. In this way the organization is self-organizing, instead of linearly organized. The interactions with the many stakeholders will lead to a lot of knowledge and information. According to the Knowledge-Based View, knowledge is the most important resource, which can lead to a competitive advantage compared to other organizations (Grant, 1996).

To summarize, complexity theory explains that different actions are connected to each other in a bigger system. To evoke these individual actions in a strategic intent an adaptive design in the form of a new logo is formed. By Imagineering, the intent is to create organizational emergence with this narrative design, through the self-organization of the individuals. The aim is to create an organization that is able to cope with the open and complex environment, because of the interactions with many stakeholders.

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2.2 Absorptive Capacity

The dynamic capabilities approach is a paradigm, which analyzes the sources that help managers to achieve and sustain competitive advantage. It emphasizes the exploiting of internal and external firm-specific routines to handle the changing environment (Teece, Pisano & Shuen, 1997). The term 'dynamic' refers to: “the capacity to renew competences so as to achieve congruence with the changing business environment; certain innovative responses are required when time-to-market and timing are critical, the rate of technological change is rapid, and the nature of future competition and markets difficult to determine”. The term 'capabilities' emphasizes: “the key role of strategic management in appropriately adapting, integrating, and reconfiguring internal and external organizational skills, resources, and functional competences to match the requirements of a changing environment” (Teece et al., 1997). Three main component factors of dynamic capabilities are: the adaptive capability, absorptive capability and the innovative capability (Wang & Achmed, 2007). To make use of the external knowledge a firm needs to possess absorptive capacity, which is defined as: “the ability to recognize the value of new information, assimilate it, and apply it to commercial ends” (Cohen & Levinthal, 1990). It is shown that the absorptive capacity is an important determinant for innovation (Giuliani & Bell, 2005; Tsai, 2001). Thereby, organizations with a higher absorptive capacity put more effort in innovation (Nieto & Quevedo, 2005).

Zahra & George (2002), however define absorptive capacity as: “as a set of organizational routines and processes by which firms acquire, assimilate, transform, and exploit knowledge to produce a dynamic organizational capability”. Besides, a distinction is made between the Potential Absorptive Capacity (PACAP), which consists of the acquisition and assimilation of knowledge, and the Realized Absorptive Capacity (RACAP), which consists of the transformation and the exploitation of knowledge (Zahra & George, 2002). The construct of relative absorptive capacity discusses the ability of firms to learn from another firm depends on similar knowledge bases, organizational structures and compensation policies (Lane & Lubatkin, 1998).

Further, Todorova & Durisin (2007) propose an extension of the model of Zahra & George (2002). The recognition of value, as identified by Cohen & Levinthal (1990) is suggested to be a step before the acquisition. Another contingent factor suggested are the power relationships that can influence the knowledge absorption processes to achieve their goals (Todorova & Durisin, 2007). Power relationships are defined as: “those relationships that involve the use of power and other resources by an actor to obtain his or her preferred outcomes” (Pfeffer, 1981).

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Figure 2. Model of ACAP (Zahra & George, 2002) 2.2.1 Acquisition

The acquisition of knowledge refers to: “a firm's capability to identify and acquire externally generated knowledge that is critical to its operations” (Zahra & George, 2002). Research on memory development proposes that assembled prior specific knowledge increases the ability of an actor to put new knowledge into the memory (Cohen & Levinthal, 1990). The ability to acquire new knowledge requires the ability to value new external knowledge (Todorova & Durisin, 2007). Accumulated prior knowledge can be developed by education and training, but also through experience. The type of assembled knowledge can affect the path that firms follow in acquiring external knowledge (Zahra & George, 2002).

2.2.2 Assimilation

The assimilation of knowledge refers to: “the firm's routines and processes that allow it to analyze, process, interpret, and understand the information obtained from external sources” (Szulanski, 1996).To ease assimilation, some part of the prior knowledge should be very closely related to the new knowledge (Cohen & Levinthal, 1990). If the knowledge is not related, the firms will not be able to analyze, process, interpret and understand this new information. Comprehension is helpful in knowledge assimilation, because it allows organizations to process and embody externally generated knowledge (Zahra & George, 2002).

2.2.3 Transformation

After identifying the external knowledge, the firm must transfer that knowledge and make it understandable (Zhou & Wu, 2010). Transformation denotes: “a firm's capability to develop and refine the routines that facilitate combining existing knowledge and the newly acquired and

assimilated knowledge” (Zahra & George, 2002). The concept of transformation is overlooked by the definition of Cohen & Levinthal (1990). However, this concept is important because it allows the firm to produce new insights, it eases the recognition of opportunities, and, it changes the way the firm sees itself and its environment (Zahra & George, 2002).

2.2.4 Exploitation

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14 emphasis is on the routines that allow firms to exploit knowledge (Zahra & George, 2002). Thus, the firm can possess some routines which allow them to exploit knowledge more efficiently than competitors and thereby create a competitive advantage.

2.2.5 Activation triggers

Activation triggers are: “events that encourage or compel a firm to respond to specific internal or external stimuli” (Walsh & Ungson, 1991; Winter, 2000). Higher learning or double-loop learning will be stimulated by triggers when these are discontinuous events, rather than by routines (Cope, 2003). Furthermore, information about the particular stimulus event that triggered the decision-making process is likely to be acquired and assimilated by individuals in the organization (Walsh & Ungson, 1991). These triggers can be internal or external to an organization. An example of an internal trigger could be an organizational crisis and an example of an external trigger could be a radical innovation or shifts in government policy (Zahra & George, 2002). As the intensity of triggers increases, the firm will heavily build its absorptive capacity (Zahra & George, 2002). An example of an activation trigger could be the narrative design from the model ‘Stairway to Heaven’. In this paper it is suggested that self-organization leads to a higher absorptive capacity in an organization.

Many studies have examined the role of the management planning to increase the absorptive capacity of an organization (Lenox & King, 2004; Jones, 2006; Jansen et al., 2005). However, the concept of organizational emergence describes rather the importance of interactions than the role of management to cope with complex problems. The role of emergence on absorptive capacity has not been developed extensively in the literature. Furthermore, Foss, Lyles & Volberda (2009) propose that there is a gap in the absorptive capacity literature of inter- and intra-organizational antecedents. Once again, according to the definition of Zahra & George (2002) the absorptive capacity consists of the acquisition, assimilation, transformation and exploitation of knowledge. It is believed that these capabilities will be higher, if the organizational emergence of an organization is high. Prior research found that deliberately changing organizational forms and combinative capabilities can enhance absorptive capacity (van den Bosch, Volberda & De Boer, 1999). The question is if this is also the case for the process of self-organization. Other factors found in the literature that enhance the effectiveness of the absorptive capacity are experience (Zahra & George, 2002) and the former experience with specific partners (Lane, Salk & Lyles, 2001; Jansen et al., 2005).

In summary, absorptive capacity is a dynamic capability, by which firms acquire, assimilate, transform and exploit knowledge and use it for commercial ends. It is suggested that if there is a higher magnitude of the activation trigger, a firm will spend more effort in building its absorptive capacity (Zahra & George, 2002). In this paper, it is investigated if an activation trigger as a narrative design could lead to a higher absorptive capacity, through the self-organization of the individuals. Thereby, exposure to diverse and complementary sources will enhance the occasion for organization to build its PACAP and social integration mechanisms increase the efficiency factor between RACAP and PACAP (Zahra & George, 2002).

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15 experience increases the effectiveness because the processes to transfer knowledge between partners are specific for a relationship (Lane, Salk & Lyles, 2001).

Thereby, as already mentioned the social integration enhances the efficiency factor, which is the gap between RACAP and PACAP (Zahra & George, 2002; Cohen & Levinthal, 1990; Jansen et al., 2005). Further, it is proposed that exposure to diverse and complementary sources will enhance the occasion for organization to build its PACAP (Zahra & George, 2002) and consequently these topics are used in forming the sub questions. In the sub questions there is also a distinction made between the effect of the generative discussion on PACAP and RACAP, as these are different aspects of the concept of absorptive capacity.

For the physiotherapist practice, the logo is an option to renew itself into a different direction. The practice has stagnated for too long and this logo is an opportunity to create a practice that is able to survive in the complex setting. The logo functions as a symbol of the different approach of the practice. This approach includes the scanning of the environment for new opportunities and to solve problems. The contribution to this practice is to motivate the employees at the hand of the logo.

2.3 Research question and sub questions

Consequently, to investigate the mechanisms behind the relationship between the self-organization and absorptive capacity, the research question is:

How does the process of self-organization (emergence) through interactions, evoked by a narrative design influence the absorptive capacity of individuals?

To answer the research question, four sub-questions are defined:

- Is an organization more effective / efficient in using external knowledge for their activities, when it is going through the process of self-organizing?

- Do interactions with stakeholders increase the absorptive capacity?

- If a generative dialogue is created, does this lead to more absorption and assimilation of knowledge?

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3. Methodology

First, a general description of the study and the case are presented in this chapter. Secondly, the data collection method is discussed. Finally, the data analysis is examined. When the business phenomenon has not been described sufficiently yet in the literature, there is a need for theory development (van Aken, Berends & van der Bij, 2012). Because the literature on the relation between self-organization and absorptive capacity is still very exploratory this paper focuses of theory development. Thereby, the aim is to get more insights in the mechanisms underlying this relation.

To make a contribution to the development of theory a case study will be performed. The case study is a research strategy that focuses on understanding the dynamics present within single settings. One strength of theory building from cases is its likelihood of generating novel theory (Eisenhardt, 1989). An explanatory case study is used because the presumed link between self-organization and absorptive capacity is too hard to explain with for instance a survey (Yin, 2003).

For this case study, ‘de Praktijk de Dobbe’ in Zwolle is chosen. This physiotherapists practice has to deal with the dynamic environment in the medical sector in the Netherlands. Due the distinction of plus practices and ‘normal’ practices by health insurance companies, and due the changes in the medical sector, the environment is changing. Plus practices are of a higher quality than ‘normal’ practices, because they meet some requirements, like extended opening hours and a short waiting time.6_{Challenges consist of the proportions between physiotherapists and health insurance}

companies, and the question if treatments should be in the basic health insurance or in additional insurances.7

These dynamics make it more complex for practices. Therefore, these practices should change their normal logic because it does not work anymore in these “post-normal times” (Nijs, 2013). All of the changes mentioned above lead to the fact that the information is changing as well. Therefore, it is important for the practice to possess a sufficient absorptive capacity to identify and use this new information. Further, the knowledge in the physiotherapist is multidisciplinary, resulting in different fields of knowledge among the workforce in the practice. Thereby, the practice consists of different networks of partners, allowing them to attain knowledge from a variety of sources.

The knowledge of the physiotherapists needs to be updated all the time, because new developments and studies are constantly arising. Furthermore, changes are necessary in the waiting time of patients, opening hours of the practice and the administration of patients. Therefore, new information is needed to improve these aspects.

This practice is attempting to become a plus practice, but the additional goal is to become a practice where management is flattened and employees are gaining more influence in decision making. By creating a self-organizing organization, the goals of flattening the management and gaining more influence for employees can be accomplished. The self-organizing organization allows the stakeholders to come up with actions, related to the strategic direction to create a collective movement. In this way, the employees can come up with more initiatives and use their creativity to cope with problems.

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https://www.zilverenkruis.nl/Consumenten/zorg/pluspraktijken/Paginas/fysiotherapie.aspx

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17 This practice has stood still for a couple of years now and the management has the intention to change this. To achieve this, the new logo is a way to present this new approach to employees and other stakeholders from outside the practice. The intention is to create an organization where individuals undertake actions with the intention to come up with new initiatives or solve problems with the help of interactions. The emergence refers to the creation of generative dialogues, leading from the self-organization.

For ‘Praktijk de Dobbe’ a new logo is part of the new way in which they want to profile themselves. This new path is a plan to close the past, a time when the practice stood still, and to move forward to a new future. Becoming a plus practice is a part of this new future, besides the new logo.

3.1 Data collection

In table 2, the steps undertaken for this research are displayed in chronological following. Step 3: the development of the ideas for the new logo, step 4: the interactive session, and step 6: the interviews with the employees, are elaborated further.

Step Description

1 Contacted the partners with plan

2 Discussed the creation of new logo

3 Created ideas for new logo and the underlying logic, according to the details discussed

4 Had an interactive session with part the

employees, which included the presentation and the feedback

5 Had some informal conversations and

observations in the practice to gain some more background information

6 Had the interviews two to three weeks later with eight approachable employees

7 Send ideas for the new logo, with the feedback of the employees taken into account

Table 2. Step-by-step procedure 3.1.1 Development of logos

The logos are created in agreement with the partners. Upfront we had a couple of conversations about what the message of the logo needed to be. It was proposed to the partners that the generative dialogue could be stimulated by the self-organization. The narrative design in the form of an idea for a new logo would evoke this process.

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18 This resulted in an idea for the new logo, as is displayed in figure 3 in blue. The logo in the other two colors: green and orange, are presented in the appendix.

Figure 3. Idea for new logo

The circles in the new logo represent the effect of rippling through and evoking something big (Nijs, 2013). The name of the practice “De Dobbe” means a pit or quarry, or a water pool.8 The rippling through of the circles to the outside is a metaphor for the initiatives of individuals that can create a bigger movement.

The circles can also be interpreted as the model of the IT lifecycle, which contains of planning, installing, management and improvement. This was suggested by the management to include in the new logo.

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Figure 4. IT lifecycle (www.net-care.nl)

“De Dobbe beweegt”, which means the dobbe moves in Dutch, has multiple interpretations. Because the main task of physiotherapists is to help their patients to move in a healthy way again, this slogan fits to a physiotherapist practice. Besides, because the message of the logo is aimed to create a collective movement it is applicable to this practice. It is intended to create an organization that is able to cope with the open and complex environment (Nijs, 2013).

This narrative design is created with the aim to stimulate the interactions of employees, both internally and externally. According to the ‘Stairway to Heaven’ model this narrative design changes the mind-shift of the employees to a relevance orientation and because of that they will change roles and relationships (Nijs, 2013).

3.1.2 Session

In the session a narrative design in the form of the developed idea for a new logo, is presented to the employees with the aim to evoke actions for self-organization of individuals. This session is an interactive session where the idea for this new logo was presented and where everyone could comment on this new logo in three different colors. In the appendix, the presentation of the idea behind the new logo is displayed.

The first session is prepared upfront with help of the partners of the practice. Together this narrative design is presented to the employees of the organization.

3.1.3 Interviews

Two and three weeks later, a number of eight interviews are undertaken with physiotherapists, secretaries and partners of ‘Praktijk de Dobbe’. This number of respondents is chosen, because of the practical reason that these were accessible. The trade-off in case studies is to have a rich story and to have a well-grounded theory (Eisenhardt & Graebner, 2007). It is believed that this number of interviews is sufficient to satisfy both these needs.

In the interviews the employees are asked about their interactions, leading from the narrative design. Thereby, the questions are about the absorptive capacity, to see if there is a difference in comparison with before the self-organization. Specifically, it is asked whether they have acquired, assimilated, transformed and/or exploited knowledge in their activities, coming forth from the interactions. The difference is measured by asking questions about their behavior before and after the introduction of the logo. In the appendix, the interview questions are displayed.

These interviews are taken individually, to research what the effects were of the self-organization for the different interviewees. The interviews are semi structured. This means that most questions are prepared upfront, but there is enough space for the interviewee to give additional information or for the interviewer to ask additional unprepared questions.

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20 opinions/attitude of the respondents. Some of the questions are more closed, but by asking why or how, the respondent can give a more elaborate answer at these questions too. The questionnaire can be found in the appendix.

Key words are developed before, during and after the interviews, to gather quantitative data. Quantitative evidence can signal relationships that are not perceived directly by the researcher (Eisenhardt, 1989). These codes help to identify some important concepts, and to measure their importance.

3.2 Data analysis

The data analysis partly overlaps with the data collection to have a head start in the analysis and to take advantage of flexible data collection. Since the data analysis is the most difficult and the least codified part of the process (Eisenhardt, 1989), the data analysis is performed in a structured way. By standardizing this process, the researcher independency of the results is improved (van Aken et al., 2012). The data collection also involves within case-analysis, which typically involves detailed case study write-ups for each site (Eisenhardt, 1989).

Thereby, the questions are structured in a way that they answer the sub questions. By answering the sub questions the research question is answered as well.

To make the results controllable, the interviews are recorded and written. Controllability is a prerequisite for the evaluation of validity and reliability. Other researches have to be able to replicate the study, to make it controllable (van Aken et al., 2012).

Another requirement of this study is the reliability. This means that results of this study not depend on the researchers, instruments, respondents and circumstances. The researcher’s bias is taken away by having standardized procedures for data collection, analysis and interpretation (van Aken et al., 2012). The respondents are selected in several layers of the organization, so that physiotherapists, secretaries and managers are interviewed. This limits the informant bias, which is having too much a one-sided perspective (Eisenhardt & Graebner, 2007). Interviewing people in diverse positions in the practice makes it possible to perceive differences between these positions. Finally, interviews are taken in a private room and the answers of the respondents are held anonymously, so that the interviewee can speak more openly.

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4. Results

This part presents the results of the interviews. At first, the realized self-organization will be explained. After the explanation of the establishment of the self-organization, leading from the logo, the results are presented per sub question.

At first, as already mentioned the practice was trying to become a plus practice in the time the interviews were held. This was part of the renovation of the practice and the logo is used as a tool to communicate the new ideas to the employees, or as one partner puts it: “I think the logo shows from which point we start and that it is something I want to make clear to the employees.”

For the analysis of the results it is necessary to make a distinction between the different roles of the interviewees in the practice, as this influences their answers. Table 2 displays the quantity of interviews with different disciplines.

Partners/Physiotherapists 2*

Physiotherapists 4

Secretaries 2

Table 3. Different roles interviewees.

* One of the partners has bought out another partner at the time of the interview; however he was already involved in the new plans for the practice. The other partner has been a partner for a couple of years already.

4.1 Self-organization

The logic of this study is that the narrative design in the form of a logo leads to self-organization. The influence of this self-organization on the absorptive capacity is investigated consequently. To investigate this relationship there has to be certainty that the logo led to the self-organization. Therefore, this paragraph will discuss the findings about the self-organization, leading from the narrative design.

The self-organization was set in motion with the session, including a presentation of the ideas for the new logo. During the session a lot of feedback was gained from the employees. But, also at informal conversations and during the interviews with employees, new ideas were proposed. The origin of these ideas was not exclusively from the employees themselves, but also from other sources, like patients, an organization in the same area with a golf in the logo to symbolize ‘De Dobbe’ and even colors as displayed on certain football shirts.

Furthermore, new actions were undertaken in the practice after the session, like “lately I saw this nice link to an article about lung problems and I shared it with colleagues”. Another example is “talking about new cooperation of the practice”. Also a thing that is mentioned is “Asking other employees where the safety lists should hang”. At last, an example is “I heard one patient who thought the waiting room was a terrible place, so I asked ten patients if they had the same experience and they did not. So I decided that it was not important.”

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22 and “everyone has the intention to make a new start”. Consequently, there is an improvement in the generative dialogue.

Overall, we could say that the new actions and the higher involvement after the introduction of the new idea for the logo are proving of a higher self-organization. Now the self-organization is explained, the effects of this on the absorptive capacity can be investigated.

4.2 More effective / efficient during self-organization

A couple of indications are found that the partners use knowledge more effective during the self-organization. In the interview, the partners were questioned if they could memorize problems they faced a half year or year ago and how they would respond now on that same situation. In both cases, the partners would handle the situation faster than before. According to one of the interviewees this is: “easy to say afterwards”. Nevertheless, the fact that they had interactions with several stakeholders, have helped them to build more knowledge about the situation and led to the fact they know how to handle such a situation more effective next time.

In contrary, the interviews revealed that the secretaries did not use the external knowledge more effective than before the self-organization. Asking them if they would handle a problem differently than before, both are clear: “No”.

For the physiotherapists, some effects are found because of the self-organization. One common problem that is faced by physiotherapists is the question if they have to send a bill to patients that did not attend the appointments. One of the physiotherapists does perceive a difference in handling this problem, as: “earlier I would never send a bill, but now I do in some instances.” By having interactions with colleagues this physiotherapist is basing the decision to send a bill or not. In this case, the physiotherapist is handling the information more effective.

It can be concluded that there are some indications of the fact that external information is used more effective than before the self-organization by the partners and physiotherapists, as situations are handled faster than before and problems are solved more effectively. However, the interviews with the secretaries pointed no differences out.

4.3 Effect different stakeholders on ACAP

At first, important stakeholders of the partners are the other parties in their networks. Networks that are mentioned are a private network of entrepreneurs, social networks, an advisory council for the pension fund for physiotherapists and a multidisciplinary network for a specific area. A lot of physiotherapists are in networks that are fixed on one specific area, like the pelvis, headache or the shoulder. These networks consist of different disciplines, like general practitioners practices, practice nurses and specialists in the hospital.

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23 in”. From this, it can be concluded that there is an improvement in the transformation of the information, and the intention is to increase this even more in the future: “That is something which we want to continue in meetings or that someone will have a demonstration and explanation on a specific time.”

Besides, the physiotherapists mention the importance of their networks too. For example the shoulder network: “which allows you to make the interactions about patients (…) for example how is the patient treated and how will the revalidation look like”. These networks allow the physiotherapists to acquire some important knowledge about the details of a patient and also for the reference of patients. The networks of the physiotherapists did also exist previously before the introduction of the logo. Yet, there are small changes in the way this information is transformed: “I have done a course about the tail bone lately and I have told that lately in a meeting” and: “we had course about pelvis last Thursday and then I thought I should keep that in mind and advice it to the patients and maybe I can try this one time.”

Also, the importance of the interactions with general practitioners is mentioned by the physiotherapists to “gain information”, “to consult” and “to cooperate”. The interactions help the physiotherapists to acquire more information and use this information in the treatment of a patient. But: “there are a lot of opportunities, but they are not exploited yet.” There is however no measurable difference found after the self-organization.

For the secretaries, the most important source of information is their colleagues. Though, there is no difference in the way how information of interactions is acquired, assimilated, transformed or exploited.

Overall, the most important sources of information for daily activities are the colleagues. All of the interviewees mention their colleagues as important source of information. The use of these interactions is effective for the daily activities, in the sense that the information which is gained by colleagues is being used, but less effective for the more organizational tasks. Colleagues are important: “to give extra information”, “as most important people to gain information” “to show new things” etcetera. There are some differences in these interactions that are mentioned in the last part of last paragraph.

In table 4, the numbers of times per interview it is mentioned by the interviewees they have interactions with colleagues and with general practitioners to gain information. This is to show the importance of these stakeholders. Thereby, it is given in which networks each interviewee is in.

Colleagues as source General Practitioners as source

Type of networks Interview 1 2 “I have introduced

frikandels and ice creams on Friday. Then we talk about things and many times when we talk about private matters, also work matters will come out.”

1 Network of

entrepreneurs, advisory council for pension fund for physiotherapists, ex-colleagues

Interview 2 7 “Sometimes I talk to a

colleague who has done

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24 the same Master, about

problems, because he has an answer to that”

Interview 3 8 “I walk regularly to the

secretaries to ask: How does this work? Or how is this settled?”

4 Havezathe

(external location)

Interview 4 4 “Now and then I walk by

and he has seen

something nice, and then he show me the nicest things, we like that”

3 Shoulder network

Interview 5 4 “In the intern audit

group we send tips to each other”

2 Pelvis network,

fellow students

Interview 6 5 “We share tips with each

other”

0 -

Interview 7 2 “We asked employees

for feedback about how they perceive the future”

1 Headache network

Interview 8 2 “We share experiences

with the system with each other”

0 -

Table 4. Number of colleagues and general practitioners mentioned as sources and type of networks per interviewee

From examining the findings, there are signals of a difference in the manner of transforming information gained from networks after the self-organization, but not in acquiring or assimilating information. Thereby, a few physiotherapists state that they have more interactions with their colleagues, regarding their daily work, which will be underlined further in the next paragraph. Finally, again no differences are found for the secretaries.

4.4 Effect generative dialogue on PACAP

The informal conversations between the employees are important for the acquisition of new information. When it is asked if people share ideas during informal meetings, it is answered: “Yes quite a lot actually”. One physiotherapist thinks that there has been a positive trend the last two weeks: “I think the informal conversations have become more”.

According to some of the interviewees, they search less for information during the self-organization, because: “I am way too busy with other things (…) for the audit (becoming a plus practice)”. It is mentioned that: “the plus practice has advantages and disadvantages (…) you have to profile yourself to belong with the others (…) it does give a lot of administration load (…) and I am afraid we will become a follower of what health insurances will impose to us”. These disadvantages have influence on the informal meetings as: “Having a coffee break for half an hour? Typing half an hour you mean!” The things cited here are related to another factor than the self-organization, namely to the work for the audit of the plus practice.

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25 the practice and if they are looking more for information related to the practice it is answered: “Yes I think it is some more than before” and “Yes it has been more lately”. Together with the findings before of the interactions with colleagues, it can be concluded there is an increase in acquiring information.

For the assimilation of information, there is no indication in the interviews that this has been changed because of the generative dialogue. Questions about recognizing information, that is an indication for the transformation, are mostly answered with: “I think that is a continuing process”. This suggests no difference in the transformation.

To conclude, it can be stated that the generative dialogue has led to more acquisition of the physiotherapists, as more information is shared during informal meetings and more information is acquired externally. For assimilation no consequence is found. Further, for secretaries no effect is found for both the acquisition and assimilation of information.

4.5 Effect generative dialogue on RACAP

A difference is found in the way that complaints of the patients are handled. Some of the interviewees say about this: “Before we handled complaints worse than now”, “lately I have heard that there were almost no complaints (…) I think they are solved well” and “complaints were not handled before, now they are”. Still there are some interviewees who mention that some complaints are just not handled or that the way they are handled should be much better, but overall it can be said that there is some improvement: “Now we have the complaint forms, we have to take steps, which is obliged so I hope that we will do that” and “it is seen as an improvement process now”. Therefore, it can be stated that there is an improvement in the exploitation after the generative dialogue.

When physiotherapists are faced with a problem in the treatment of patients, colleagues are sometimes asked: “for feedback” and “to look at a hip or shoulder, which I cannot loose up totally.” Some of these physiotherapists do perceive a difference as they: “refer more to colleagues than before” and “I ask information from other people now”, but other colleagues do not perceive a difference: “No I don’t think so. I know my own weaknesses and I am always asking the question to myself: can it be done better and am I on the right track?” However, together with the findings before about the physiotherapists mentioning they solve problems differently and faster, it can be stated that there is an increase in the way that the knowledge is exploited.

Overall, it can be said that there is a more mutual vision in the practice now, then there was before: “I think it has become some better” and “{difference?} Yes, I think for some it has become clear that we have to do this”. This vision is an indication of a higher transformation in the practice. Thereby, paragraph 4.3 gives some example of how information of networks is better transformed now. To conclude, there are a couple of signals to presume there has been an effect of the generative dialogue on the RACAP. In the whole practice it is discovered that the vision is more common than before and that handling complaints has been improved and that specific problems are handled differently, indicating an increase in the transformation and exploitation of information.

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Differences

Acquisition More external interactions more interactions with colleagues

Assimilation -

Transformation More a mutual vision

More new ideas and thoughts about ways to solve problems

Transforming information from networks

Exploitation Solve problems differently

Solve specific problems faster than before Better coping with complaints

More references to colleagues

Table 5. Changes per dimension of ACAP, because of generative dialogue

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5. Discussion

This part discusses and summarizes the findings as have been displayed in the paragraph before. These results are compared to the literature to analyze if these results support the theory. After this, new propositions are suggested.

The purpose of this paper was to investigate the underlying mechanisms of the relationship between self-organization and absorptive capacity. By introducing an idea for a new logo in three different colors in a physiotherapist practice, the intent was to effectuate an emerging organization, through the self-organization of the individuals. The effects on absorptive capacity were investigated by means of eight interviews in the practice. To investigate this, the research question was split up in four sub questions. They will be discussed separately in the next paragraphs. Finally, an answer on the research question will be presented.

5.1 More effective / efficient after self-organization

The results show that there are a couple of findings, proving the more effective use of external knowledge after the self-organization. These findings include the fact that problems faced in the past, are handled more effective now and the treatment of patients have become more effective because of the interactions.

Two factors which enhance the effectiveness of the absorptive capacity are experience (Zahra & George, 2002) and the former experience with specific partners (Lane, Salk & Lyles, 2001; Jansen et al., 2005). The results indicate that the self-organization is creating a more effective use of external knowledge. This self-organization leads to a creation of an emerging organization, through the many interactions and the co-creation of value. Having many interactions could lead to new experiences in general and with new partners, therefore increasing the effectiveness. Consequently, self-organization leads to the enhancement of the upper factors and therefore to a higher effectiveness.

Proposition 1: An organization is more effective in using external information after self-organization

For secretaries no effects are found, which could be explained because their task is quite straightforward: “it is clear what your task is and what you have to do, there is not much changing about that”.

Besides, the efficiency of using external information is established by social integration (Zahra & George, 2002; Cohen & Levinthal, 1990; Jansen et al., 2005). There is no clear indication that there has been more formal integration, but the self-organization does lead to more informal integration, as the interactions of the colleagues and the use of this information increase for physiotherapists.

5.2 Effect different stakeholders on ACAP

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28 similar multidisciplinary interests lots of information is shared and gained. This underlines the importance of similar knowledge bases for the absorptive capacity.

Considering the results, after the self-organization, especially more transformation arises, regarding the information gained from the networks and more acquisition arises, regarding the information of colleagues. It appears that the self-organization increases just parts of the absorptive capacity. Apparently, there were a lot of connections with networks already, but these were not shared yet by the physiotherapists. Thereby, it is evident from the results that there is more acquisition of information after the self-organization.

The fact that there is an increase in the transformation of information gained by networks can partly be explained by the social integration. The use of social integration increases the efficiency factor, which is the gap between the RACAP and PACAP (Zahra & George, 2002; Cohen & Levinthal, 1990; Jansen et al., 2005). The meetings could be seen as a formal integration and in this way the gap between PACAP and RACAP can be bridged.

The fact that there is an increase in the acquisition of information from colleagues is not explained by social integration mechanisms and can be seen as an effect of the self-organization. Hence, it can be concluded that the self-organization stimulates the acquisition of information of colleagues. Further, it is a logical effect that the acquisition of information from colleagues is higher, because of the creation of an internal dialogue.

5.3 Effect generative dialogue on PACAP

The effect of the generative dialogue on PACAP has been discussed in part previously. There is an additional finding that relates to this sub question, specifically that more information is shared in informal meetings. Besides, this result is related to the acquisition of information, as informal meetings are good opportunities to exchange ideas. It has become clear that the self-organization led to the fact that there are more informal conversations and that people have become more involved. Thereby, there have been some interviewees stating that they approach more external people for information. The arguments from this paragraph and the previous paragraph lead to the following proposition.

Proposition 2: Self-organization stimulates the acquisition of information

Once again, no difference is found in the assimilation of information. Therefore, no difference is found for the interviewees to analyze, process, interpret, and understand the information, leading from the self-organization (Szulanski, 1996). A possible explanation could be the fact that the employees already possess a sufficient ability to analyze, process, interpret and understand the information, because of the education and/or work experience. Another explanation could be that it will cost some more time before an increase in the transformation is visible.

5.4 Effect generative dialogue on RACAP

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29 Transformation consists of the combination of existing knowledge with the absorbed external knowledge (Zahra & George, 2002). Creating a more common vision, consists of interactions to share ideas and coming to a mutual agreement. The self-organization is a logical mean to stimulate these interactions. Thereby, the self-organization also led employees to share ideas more, next to the meetings.

Furthermore, the exploitation is based on routines to exploit the knowledge (Zahra & George, 2002). There are signals of improvement in these routines in the practice by handling complaints and other specific problems in a better way. The complaints are seen as an improvement process for the practice now more, that is creating a better exploitation. Thereby, patients are referred more to other physiotherapists and problems are solved faster or differently. Therefore, the statement is:

Proposition 3: Self-organization stimulates both the transformation and exploitation (RACAP) of knowledge

5.5 Effect self-organization on ACAP

At last, the most important question will be answered: does the self-organization lead to a higher absorptive capacity of individuals? Based on table 5, some differences are perceived by the interviewees. Overall, it can be concluded there has been a slight increase in the absorptive capacity of the practice.

It is already proposed by Zahra & George (2002) that having more exposure to diverse and complementary external sources of knowledge, the greater that the opportunity is for a company to develop its PACAP. Self-organization could be a good way to gain more exposure to these sources by looking for interactions to solve problems or come up with new initiatives, to create something new. Besides the direct interface with the external environment, the absorptive capacity also depends on the transfers of knowledge across and within subunits (Cohen & Levinthal, 1990). Through the interactions of the components (Lansing & Kremer, 1993), resulting from the process of emergence the transfer of knowledge is likely to be more present too within the practice.

Thereby, it is also mentioned that an activation trigger will influence the relationship between the source of knowledge and PACAP (Zahra & George, 2002). In this study, the activation trigger has been the narrative design. What is however remarkable that both points above mention the increase in PACAP, while the findings of this study mostly found indications of the RACAP. The signals of an increase in the acquisition and RACAP lead to the following proposition.

Self-organization and absorptive capacity