Table 5 Summary of management and role of knowledge

Dimension “people”

• Absence of a mutual learning culture specifically for HRMDs.

• Inadequate knowledge sharing culture to manage complaints.

• No sustainable commitment to clinical knowledge-informed quality assurance programmes.

• Need to engage people in generating knowledge.

• Organisations unable to generate knowledge.

• Uncertainty how to apply knowledge correctly

• Failure to identify the relevance of post-market surveillance data.

Dimension “organization”

• Absence of structures to improve handling and management of complaints and adverse events across departments.

• Absence of structures to obtain adequate information of data from clinical procedures.

Dimension “management”

• Opportunities to develop strategies that merge the interests of the different sectors to achieve federal knowledge goals.

• Need for improved exchange of information between federal units and insufficient to create synergies.

• Opportunities to implement strategies that can adequately measure e.g. the clinical performance of MDs.

Dimension “information technology”

• Insufficient implementation of electronic patient data collection and records.

• Lack of infrastructure for collecting national post-market surveillance data.

• Need for an application that monitors performance of MDs in clinical use.

Role of knowledge

• Rigid evaluation criteria like demand calculation.

• Lack of orthopaedic experts on decision-making committees.

• Importance of lowest acquisition price.

• Feedback loop on performance of HRMD between users and administrators.