Internal versus external knowledge sourcing of organizational rules: an exploratory study of CPGs in a healthcare organization

In this study, we examine how organizational rules source knowledge. By knowledge sourcing of a rule, we mean the formation of reference ties from the rule to knowledge sources located outside of the focal rule. Rules can source knowledge from sources within the organization (e.g., other rules) and outside (e.g., research publications, policies, standards, etc.). Our theoretical model proposes that knowledge sourcing of rules is driven by inherent incompleteness of rules as a result of bounded rationality of rule makers and rule making process. Incomplete rules can lead to experiences of insufficient rule knowledge, termed “knowledge gaps,” which are shaped by rule dynamics at the levels of individual rules, the rule system, and rule networks. Our theoretical model leads to several hypotheses that we test with longitudinal archival data of clinical practice guideline (CPG) changes in a Canadian healthcare organization. The findings support our theoretical model of incomplete organizational rules which encounter knowledge gaps and close them through internal and external knowledge sourcing. The theoretical and practical implications of the findings are discussed.