The status of human knowledge capital development

Chapter 1




The knowledge economy has advanced considerably, over the years, consequently forcing organizations to shift their focus from intangible assets to tangible assets, and specifically to human knowledge capital (Bontis, & Fitz-enz, 2002, pg. 231). Tangible assets, in this case, refer to those items that are normally found on a company’s balance sheet, such as machinery, property and plant, to name but a few tangible assets (Chen, Cheng, & Hwang, 2005, pg.163). Apart from people and their expertise, which is essentially what human knowledge capital encompasses, we also have business processes and reputation, customer loyalty, and other market assets, all of which have attracted the attention of today’s corporate managers (Ordónez de Pablos, 2002, pg. 294).  Ordinarily, human knowledge capital, together with structural capital and relational capital make up intellectual capital, which is undoubtedly the main factor that is responsible for generating future growth and prosperity, the evidence of which  can be found in the fact that it combines with brands, processes, systems, customers and databases to generate corporate competitive advantages for an organization. It is important for us to understand that we are at that point in time when the optimal combination of information, communication and, most importantly, knowledge, is the actual power behind corporate success. This means that the greater the organization’s know-how, the greater its success over its competitors. Moreover, it means that people are at the core of corporate success, thus aligning clearly with the literature on competitive advantage, which is all about people learning, people knowing and people communicating. Without doubt, it is “the decade of the people side” just as the management guru, Wayne Brockbank (2001), stated in one of his numerous past interviews.

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Human knowledge capital is staff-dependent, which basically means that it depends almost entirely on: employees’ learning, education, experience, expertise, innovation, creativity, loyalty, and motivation, etc. Although it is recognized as a major constituent of intellectual capital, a distinctive feature of human knowledge capital is that it diminishes, the moment employees’ learning, education, coaching, creativity, innovation, experience programs cease (Bontis, 1999). Contrary to human knowledge capital, structural capital resides in the organization, whereby it comprises of organizational infrastructure, and innovative capital to name but a few essential internal assets. However, it is extremely important to note that these infrastructure and other physical assets are nothing, without the input of the employees, of the so-called human knowledge capital. Relational capital, on the other hand, is rooted in relationships that the organization has cultivated with employees, suppliers and customers, relationships that are embodied in features such as the shared paradigm that inculcates a common understanding of shared goals and appropriate ways of acting, in a social system involving others (Tsai &Ghoshal, 1998). Once again, an organization’s staff or its human knowledge capital is an important component in establishing the type or relationship with suppliers and customers that can guarantee an organization the requisite competitive advantage.

As is the case with relational capital, the theoretical impact of human knowledge capital on an organization’s performance is yet to be exhausted, or fully explored, in the literature. In fact, quantifying correctly this important element (human knowledge capital) is, in itself, a huge challenge for the majority of researchers, in this area. This is despite the importance that is placed on successfully fulfilling the strategic partner role that is thought to exist between the organization and its human knowledge capital. Evidence of this can be found in the findings of a study conducted by ISR, a consulting company involved in employee research and which showed that, although most organizations collect their metrics relating to their respective human knowledge capital, only a small number (less than half) actively evaluate the impact of their human knowledge capital on business performance.  It is, however, important to note that a large amount of empirical research is still investigating this particular issue. The purpose of this research study, therefore, is to investigate the impact that an organization’s investment in its staff, namely in their education, learning, coaching, and their creativity, innovation, and associated experiences, all of which, collectively, determine the effect of an organization’s collective human knowledge capital, at any given time, on its overall performance.

Ordinarily, maintenance projects in labour-intensive organizations do not provide a high professional knowledge and the corresponding, relevant high-end technologies; nor do managers of such projects, generally, possess the type of cutting-edge professional expertise that is normally found in knowledge-intensive organizations. This, however, is not the case with King Faisal Specialist Hospital and Research Center (KFSH & RC), which is actually very similar to other knowledge-intensive organizations that provide high-level professional knowledge and corresponding technologies, together with a huge pool of professional managers with outstanding knowledge in its maintenance projects. Naturally, maintenance projects are knowledge-intensive undertakings for which the human knowledge capital of the staff is of paramount importance (Mayo, 2000, pg. 526). This is, essentially, because knowledge, in itself, is the greatest component in maintenance projects, which therefore requires equally high-calibre management to match the excellent human knowledge capital, especially where its impact on the operations and the overall management of the organization are concerned (Brown, et al., 2007, pg. 81).



Located in Saudi’s capital, Riyadh, KFSH & RC is a modern state-of-the-art medical facility, which is undoubtedly the largest in the entire Middle East. A national referral centre for organ transplantation, oncology, cardiovascular diseases, genetic diseases and neurosciences, and a provider of a full range of primary, secondary, and tertiary health care services, KFSH & RC is recognized as a major referral centre, both nationally and internationally. Among the services that KFSH & RC has pioneered, in the Middle East, are the procedures for marrow and kidney transplantation, cardiovascular and orthopaedic surgery, IVF and oncology, etc. KFSH & RC perform a total of approximately 2,000 open-heart surgeries and 6,500 cardiac catheterizations, annually. KFSH & RC’s Research Center focuses on both translational and basic research in transplant immunology, genetics, cancer, cardiovascular conditions, proteomics, and molecular diagnostics. This Research Center has four departments, namely: Cyclotron and Radiopharmaceuticals, Biostatistics; Scientific Computing; and Biomedical Physics. All these services which are offered at KFSH & RC require a maintenance team that is not only highly qualified intellectually, but also up-to-date on current developments and knowledgeable about the latest tools, equipment and leading technological aids needed to maintain such high-level services.  This team comprises of a broad range of professionals of various different nationalities. In fact, a large part of this team is made up of expatriates, with a mere 20% being Saudis. The work of this team no doubt has a decisive impact on the overall performance of the organization. This is better demonstrated by the fact that any unresolved breakdown of vital machines or technological equipment is likely to have an adverse effect on the performance of the medical staff, in general, and therefore on the overall organization(Helen Ziegler and Associates, 2011).



To date, very little attention has been focused on the study of human knowledge capital in maintenance projects, in medical facilities, such as KFSH & RC (Hubert, 1996, pg. 11). This is despite the fact that KFSH & RC has been performing exceptionally well, as can be seen in its financial performance, over the years. Otherwise, how might one explain its exceptional performance, over the years, especially after the completion of the Cyclotron Section? Arguably, this shows that the financial markets and investors attach considerable value to the learning, education, experience, expertise, innovation, and creativity, and skills of CEOs and top management, in general (Bontis, 2001, pg. 45). According to a number of recent studies, knowledge and information are subject to increasing returns, which is different from the decreasing returns characteristic of more traditional resources (LeBlanc, et al., 2000, pg. 15). This, therefore, makes knowledge and information much more attractive to corporations, than previously (Combs & Skill, 2003, pg. 67).In this context, therefore,  a survey will be conducted, with a view to obtaining a better understanding of the attainment and the status of human knowledge capital development relating to the maintenance project in KFSH & RC. This survey will also enable the author to examine the influence that exists between human knowledge capital and performance, in project management, in this facility.

The traditional metrics of human knowledge capital have, so far, proved incapable of measuring the extent to which human knowledge capital contributes to the economic performance of medical facilities (Chen, Cheng & Hwang, pg. 166). Even the frameworks that have been in use for identifying the major drivers of organizational overall performance are all based on a decade of research, without much modern input (Chen, Cheng & Hwang, pg. 169). They have also, hitherto, been unable to provide the answer as to whether an investment in human knowledge capital has a positive or negative influence on the performance of medical facilities.


Although this research study is focused on a maintenance project in medical facilities and KFSH & RC, in particular, it is, however, imperative to note that maintenance projects, by their very nature, are very much knowledge-intensive. This means, therefore, that when conducting any research into maintenance projects, it is essential to understand, from the outset, the potential link that exists between human knowledge capital and the overall performance of an organization, regardless of the industry in question or of the specific maintenance project study being undertaken. Therefore, by exploring the effect that staff training, learning, coaching, and overall creativity, innovation and the experience of the members of staff involved in maintenance projects, it is possible to ascertain the extent of this positive effect on the organization’s overall performance.



 A broad range of literature, drawn from various sources, on the impact of learning, education, experience, expertise, innovation, and creativity on an organization’s performance has been looked at, for the purpose of this study. Previous research into the relationship between an organization’s human knowledge capital and its performance has clearly demonstrated that the two are inter-related, with the organization’s performance being firmly based on its intangible assets, such as individual employees’ capabilities and goodwill. However, the existing research does not discuss this relationship, in any great depth. In this respect, previous research has only explored a few aspects of this complex relationship, including features such as commitment and trust, for example. This study aims, therefore, to obtain a deeper and more comprehensive understanding of this relationship, drawing on various studies of the human knowledge capital concept in project management. More specifically, the study will analyze the impact of the various dimensions (learning and education, experience and expertise, innovation and creativity) of human knowledge capital on an organization’s performance, before going on to summarize the findings and draw conclusions about the impact of knowledge capital on an organization’s overall performance.


Bontis (1996) pointed to the important role played by production equipment in an organization’s success, during the 20th century, as compared to that of the “knowledge worker” and their corresponding productivity, during the 21st century. Today, knowledge is undoubtedly one of the most essential constituents of modern-day production which therefore places efficient management of the internal dealings of the organization, at the core of business management. Nevertheless, as with any other knowledge-intensive enterprise, it is expected that the King Faisal Specialist Hospital and Research Center (KFSH & RC) maintenance project will still require a huge tranche of intangible assets that will not be mirrored in its financial statement. However, although it might prove difficult to analyze the management of KFSH & RC, in detail, the impact of the knowledge aspects in such projects, e.g. learning, education, experience, expertise, innovation, and creativity on its personnel is an issue of which KFSH & RC is very much aware. It is, therefore, extremely important for an organization’s managers to discuss how best to manage these knowledge aspects, so that they can improve their performance in project management, as well as the operational performance of the enterprise, in general.



An ongoing debate in labour economics’ literature on the subject of whether organizations can profit from learning, education, experience, expertise, innovation, and the creativity of its staff has been raging, for many years. Prior to the introduction of Becker’s theory on the training and education within the organization, the majority of the economists thought of staff training, education, learning, creativity, and innovation as essentially an individual’s investment decision.




Research Hypotheses for this project is as follow:


There is a link between the training, coaching, learning and creativity, innovation and experience of the maintenance staff, who undertook the Cyclotron operation section upgrade project, in 2011. This applies to the overall performance of KFSH & RC. Training, coaching, learning and the experience, expertise, innovation, and creativity of the members of staff involved in this project refers to the human knowledge capital of KFSH & RC.



1.6       Research Objectives


  1. To examine the link between the learning, education, experience, expertise, innovation, and creativity of the maintenance staff who undertook the Cyclotron operation section upgrade project, in 2011, and the overall performance of KFSH & RC.
  2. To demonstrate that investment in learning, education, experience, expertise, innovation, and creativity for the KFSH & RC maintenance staff who undertook the Cyclotron operation section upgrade project, in 2011, had a positive effect on the overall performance of KFSH & RC.
  • To explore whether investment in human knowledge capital (learning, education, experience, expertise, innovation, and creativity) is appropriate to the value added to KFSH & RC.




  1. Is there is a link between the learning, education, experience, expertise, innovation, and creativity of the KFSH & RC staff who undertook the Cyclotron operation section upgrade project, in 2011, and the overall time performance in a maintenance project and its physical assets?
  2. Did the KFSH & RC investment in the learning, education, experience, expertise, innovation, and creativity of its maintenance staff who were involved in the Cyclotron operation section upgrade project, in 2011, improve time performance in that particular project and the overall output of the medical facility, in general?
  3. Is the learning, education, experience, expertise, innovation, and creativity of maintenance staff in the Cyclotron operation section upgrade project, in 2011, appropriate to the value addition for KFSH & RC, in general?



 This research study will focus on the 2011Cyclotron operation section upgrade project, undertaken early last year, within KFSH & RC. It is anticipated that the research findings will contribute towards an explanation of the potential link between human knowledge capital, or investment in staff’s learning, education, experience, expertise, innovation, and creativity, and an organization’s overall performance, which is a general question that is asked, not only in the context of maintenance projects in the medical industry, but also in all other sectors of the economy. The almost total reliance on human resources or the so-called human knowledge capital in a project of this nature is the specific driving force behind this research study. This is because it brings into focus the suggested link between human knowledge capital and the overall performance of an organization.




Chapter 2 (Literature Review) explores the context in which human knowledge capital is being examined, together with identifying the main elements of the concept (learning, education, experience, expertise, innovation, and creativity), and its relationship to other complementary types of capital, notably intellectual capital, organizational and social. It will also assess the case for human knowledge capital having an impact on performance, for which evidence is growing, increasingly, while examining mechanisms for measuring staff learning, education, experience, expertise, innovation, and creativity(Robinson &Kleiner, 1996, pg. 36).  It is from the evidence of this examination that the implied relationship between staff learning, education, experience, expertise, innovation, and creativity and organizational performance will be better established.


Chapters 3 and 4 (Methodology: Results and Analysis) examine the third aim of the dissertation by exploring whether an investment in staff learning, education, experience, expertise, innovation, and creativity has any effect on an organization’s performance.


Chapter 5 (Conclusions) looks, critically, at the research, analyzing the methodology, together with identifying areas for further research.


Chapter 2



Today, information and knowledge are the main drivers of global, commercial enterprise, even more so than labour or capital, as was the case, in the past.  What this means to managers is that the increased importance of knowledge not only adds an extra variable to the production process but most importantly, this shift in emphasis has radically changed the rules and dynamics of the business arena, worldwide. This concept is perfectly captured in the opinion of Quinn (1992), where he acknowledged the importance of the manager’s ability to manage the knowledge-based-intellect in today’s business environment.  It is also echoed by Savage (1990), when he claimed that the wealth-creating ability of a business will be determined, primarily, by the knowledge and capabilities of its employees. Furthermore, Drucker (1993), the management guru, recognized the emergence of a new economy which he referred to as the “knowledge society”, in reference to the increased significance of knowledge and expertise in today’s corporate environment.  Moreover, Drucker argued that, in this so-called “knowledge society”, knowledge (learning, education, experience, expertise, innovation, and creativity) are not just another resource, alongside the traditional resources of labor, land, and capital, but the only resource that is meaningful, in this time and age.

The body of literature demonstrating the presence of a positive link between the development of knowledge capital or investment in staff learning, education, experience, expertise, innovation, and creativity and an organization’s overall performance is becoming more evident, with each passing day. The emphasis on human knowledge capital in an organization emanates from the view that market value depends more on intangible assets and especially on human resources, rather than on tangible resources (Stewart, pg. 16). This does not, however, render staff learning, education, experience, expertise, innovation, and creativity as the only driving force in an organization’s performance, but merely a portion of the equation.


Maintenance projects in medical facilities are knowledge-intensive, in nature, precisely because maintenance designs essentially depend on the creativity, learning, education, experience, expertise, innovation, creativity and ingenuity of the organization’s staff. This sector has, over the years, grown into a multi-disciplinary service provider that comprises a wide range of professionals, which is consistent with the ever-increasing complexity and demand for medical technology.

This application of knowledge, ingenuity, and expertise is a manifestation of the over-riding importance of human knowledge capital in any maintenance project, irrespective of the industry (Johnson, 1996, pg. 567). That being the case, therefore, it is always important to mobilize and incorporate knowledge from a large pool of disciplines, in any maintenance project, if the desired efforts are to be realized, to full effect, by the respective organization, in any such maintenance project. Also, it is imperative that the outcome is consistent with the client’s requirements and that the end product is both multi-functional and capable of being applied, in different functions (Johnson, pg. 568). This is particularly important, in that it offers the contractor goodwill, which is important in this sector, particularly as contracts of this nature normally adhere to the principle of trading first, and production second.  It is also important in maintaining standards, especially because the performance standards and acceptance checks are susceptible to variations in the interpretation of the various clauses (Buren, 1999, pg. 73), not to mention the fact that long-term operation of this type are prone to changes in economic fluctuations, government policies and other exogenous variables.

The above situation is very closely mirrored in the Cyclotron operation section upgrade project, in 2011, which forms the subject of this research. Installed in 1982 at KFSH & RC, the Cyclotron section, which first went into operation, in 1983, has been a major factor in the success of the entire radiopharmaceutical program.

A cyclotron works by producing the accelerated sub-atomic particles that can be used to produce radionuclides that can be used in the medical world. The neutron deficient radio-nuclides that are produced when the target is struck by these sub-atomic particles are the main source material used in preparing radiopharmaceuticals. Other than the target stations that are availed in seven beamlines, there is also an internal target system that is fitted with an isorabbit device for the remote transmission of the irradiated targets, to guard hot cells for remote production of radioactive materials. This section also builds up new targets and other enhancements to the technology, with the main aim of enhancing production and efficiency. Being the first connection in the radiopharmaceutical production chain, the cyclotron needs to be extremely reliable, at all times, despite its technological complexity. This requirement, coupled with its complexity, shows just how vital a competent and updated maintenance team is to the overall success of the organization.

From the above discussions, there is no doubt that a maintenance project of this nature requires the support of as large a collection of diverse and technical expertise as is practically possible. For instance, the Cyclotron operation section that was responsible for the Cyclotron operation section upgrade project, in 2011, and any other future improvement and maintenance included civil engineers, architects, nuclear scientists, and engineers specializing in the biomedical fields. The engineering group, in particular, had to have the necessary equipment, in place, as well the capacity to up-to-date training on designing, testing, and troubleshooting vacuum, electronic and electromagnetic systems. The department’s radiation safety system that was also being upgraded required a great deal of electronic expertise and computer-aided-design facilities.

Mobilizing a team that is intellectually equipped to undertake as complex a project as the one being discussed in this paper might not be an easy task. Therefore, ensuring that they are always abreast of the latest developments in the industry requires a program that ought to incorporate in-house training, education and learning on the latest developments. The challenges involved in handling such projects are such that the professionals undertaking these projects need to stay abreast of the latest developments in their respective fields, through learning, training and education if their collective efforts are to deliver the desired results that not only satisfy the client’s requirements but also give the organization a good reputation and hence a competitive edge.



The issue of what exactly gives an organization a competitive advantage has seen a shift in emphasis away from external resources and the comparative balance of competitive forces, towards an acceptance that internal resources be viewed as essential to sustained effectiveness (Wright, et al., 2001, pg. 701).  The origins of the resource-based concept (RBV) can be traced back to the work of Penrose (1959), which was later re-iterated in subsequent studies, by the likes of Rumelt (1984), Dierickx& Cool (1989) and Barney (1991, 1996). One of the greatest inputs of the RBV, in this debate, is that it created the urgent need for an organization to mobilize a valuable set of resources and incorporate them into a specific and dynamic approach to consolidating the organization’s success (Boxall, 1996, pg. 63).

Traditionally, competitive advantage was dependent on the technologies, natural resources and economies of scale, bases that unfortunately have become increasingly easy to imitate. Today, it is only through using valuable, hard-to-imitate, rare resources that typically exist within most organizations, that it is possible to gain the necessary competitive advantage. In this respect, knowledge capital in the actual sense is an “invisible asset”, which is attainable through learning, education, experience, expertise, innovation, and creativity (Itami, 1987). The organization of the knowledge capital pool, or the collection of employee capability and its management through the human resource, therefore becomes evident. Snell, et al., (1996) argue that, if the type and level of knowledge are disproportionately distributed, in such a way that some organizations’ employees are able to acquire the skills that they require through learning, education, experience, expertise, innovation, and creativity, while others cannot, then, ceteris paribus, that kind of knowledge capital can become a major source of sustained competitive advantage.

Inimitability is another important virtue of human knowledge capital (Lepak& Snell, 1999, pg. 37). There are two main reasons that make human knowledge capital difficult to imitate, namely: path dependency and causal ambiguity (Berker&Gerhart, 1996, and Barney, 1991). Causal ambiguity, in this case, refers to difficulties that reside in any attempt at grasping the exact mechanism through which the interplay of human knowledge capital practice and policies create value.  By being path-dependent, these knowledge capital systems’ policies developed, over time, cannot simply be purchased in the market by other players in the market. If anything, they are perpetually changing (Berker&Gerhart, pg. 782). The interdependency between human knowledge capital practices and policies, combined with the distinctive context of specific companies, creates barriers to any form of imitation. To quote Boxall, human resources ought to be “latent with productive possibilities” (Boxall, 1996, pg. 67), which therefore means that human knowledge capital advantage depends not only on securing what is often referred to as “the best and the brightest”, but also on investing in staff learning, education, experience, expertise, innovation, and creativity.

This emphasis on human knowledge capital is also highlighted in the strategy research on the so-called “core competencies”, where economic rent is ascribed to what Hamel and Prahalad call “people-embodied skills” (Hamel &Prahalad, 1994, pg. 232). It is this increased importance of RBV that has driven the advancement of human capital management, in general, and human knowledge capital, in particular, over the years, not to mention the convergence between the various fields of HRM and the strategy that has been developed, over the same period (Wright, et al., 2001).

The resource-based view reinforces the common belief in strategic human resource management, where people are the greatest source of organizational success (Roberts, 1995, pg. 43). Although, Michael Hammer argues that the age-old statement “people are the greatest assets” is not necessarily played out, in contemporary American business, the rise of human resource management has been spectacular (Truss, 2001, pg. 24). This can be traced back to the 1980s, with the analysis of the concept of “Japanese miracle” which was emerging as a viable route to success in the commercial arena; an analysis that among others showed that success built on an idiosyncratic form of people management, and by the recommendations received from the excellence movement (Collins &Porras, 1994).

Looking at the Cyclotron operation section upgrade project, in 2011, in KFSH & RC, there is no doubt that any failure on the part of KFSH & RC to invest in learning, education, experience, expertise, innovation, and creativity for the employees engaged in the maintenance department dealing with cyclotron operation would result in the reduced overall effectiveness of the entire medical facility. This is primarily because of the pivotal importance of the cyclotron section to the rest of the departments in the hospital dealing with the patients’ treatment. A recent investigation that sought to establish the perspective of both the organization and the client on the differing requirements, as far as the maintenance project performance was concerned pointed out that the realization of the targets and objectives, compliance to the client’s requirements, identification of both the objective of project and requirements of the clients and compliance to government policies and legislative requirements were the main criteria that clients use in their evaluation of a project’s performance  (Tyson, 1997, pg. 15). The investigation went further, highlighting the importance placed on the criteria applied in the design stages, vis-à-vis those used in other stages. Other significant findings have focused on the differing opinions and attitudes towards certain essential factors in the overall maintenance project.  For instance, in the case of the “King Faisal Specialist Hospital and Research Center”, it was revealed that the project’s maintenance, cost, security, and timescale had been severely underestimated. It is, therefore, of the utmost importance to maintain seamless co-ordination with the client, in order to achieve the maintenance requirements of the project, in hand.



Currently, considerable emphasis is being placed on human knowledge capital by the majority of knowledge-intensive organizations, primarily because the market value of these types of organizations exceeds that of its physical assets (Stewart, 1999, pg. 23).   Human knowledge capital, just as the name suggests, refers to the sum total of the know-how and ability of the entire staff which, in turn, not only creates wealth, but also generally improves the organization’s long-term performance. Nahapiet&Ghosal (1998, pg. 251) and Bontis (1998, pg. 65), on the other hand, define human knowledge capital as the knowledge and know-how capability of the workforce in the organization, which is best obtained through staff learning, education, experience, expertise, innovation, and creativity. A closer look reveals the fact that human knowledge capital is a subset of intellectual capital; as, indeed, is the case with structural capital.

The distinction between the return on investment in staff and the intellectual capital ought, not only be respected by the organization, but also managed with the precision and intensity that is on a par with that of other intellectual capitals (structural and relational) and financial capital, as well (Maruping, 2002, pg. 6). It is important to understand that no monetary value can be placed on the organization’s know-how, its staff learning, education, experience, expertise, innovation, and creativity capacities (Ulrich, 1998, pg. 21). The market value of this “human knowledge capital” will obviously be presented as an asset; however, it’s market value will always differ among markets (Bontis, 1998, pg. 73).


Even in the face of the increased recognition of human knowledge capital in fueling the value of an organization and its resulting competitive advantage, a proper measure of an organization’s human knowledge capital is yet to be established, as would be expected (Chen, Cheng & Hwang, 2005, pg. 165). If knowledge is the key determinant of an organization’s future performance, but is not sufficiently reflected in the accounting financial measures and, if financial measures are essentially the main drivers of the decisions of top management, then what measuring system would be appropriate in fulfilling the conditions of the new economy and the requirements of modern organizations (Brown, 1999, pg. 29)? The exclusion of an organization’s human knowledge capital from its financial statement, as it is traditionally prepared, therefore denies the management and other stakeholders a proper picture of an organization’s worth or its actual performance.


A number of measures have been developed, over the years, in an attempt to present an organization’s human knowledge capital capabilities. Among these, Economic Value Added (EVA), Human Resource Accounting (HRA) and Balanced Score Card (BSC) are the most commonly discussed measures in the arena of research (Williams &Bukowitz, 2001, pg. 99). The author of this research will not be applying any of these measures, but, instead, one that involves measuring the employees’ learning, education, experience, expertise, innovation, and creativity. Several organizations have made significant efforts in reporting their human knowledge capital.  For instance, Skandia has, since 1994, made efforts to modify its balance sheet, in a way that not only incorporates its human knowledge capital, which gives it the bulk of its market value, but most importantly, makes more sense in the changed environment. Other companies that have adopted similar strategies are found mainly in the services industry and other commercial enterprises, such as management consultants, software-development start-ups, healthcare and life sciences, law firms, media and entertainment and high-technology ventures, all of which rely primarily on people (Bontis, 1998). Even the majority of leading business schools around the world have started planning to redesign their programs, in a way that reflects: human knowledge capital, knowledge management, organization learning, and other initiatives of the “knowledge era” (Rastogi, 2000, pg. 43).

In this particular study, human knowledge capital will be subdivided into three closely related sub-dimensions, namely: learning and education, experience and expertise, and innovation and creation.



Human capital is an essential component of intellectual capital. It encompasses the skills, knowledge and expertise of the managers and the staff, together with their ability to handle situations, in advance, not to mention their entrepreneurial capabilities (Cohen, et al., 2007).  For the organization to enjoy the maximum benefits of human knowledge capital, consistently, its strategic management must put in place a system that ensures that its employees are abreast of the latest development in their respective fields through offering them appropriate training, education, experience and mentoring on how to tap on the synergy of the collective wisdom, effectively (Bartel, 1994, pg. 416).  However, this teaching, training, education and mentoring should not overemphasis the importance of improving their individual competencies (Thomson, 2000, pg. 31); rather, it should place an emphasis on why such an effort is important, not just to the organization, but also to the individual employee, as well (Mayo, 2000, pg. 527). It is in this regard that a system of continuous learning needs to be in place, so that added value in the project can be assured, using this newly acquired, cutting-edge knowledge from the professionals, at all time (Graetz, 2002, pg. 458).

Despite the age-old fact that workers are an organization’s most valuable assets, it is unfortunate that the owners of these enterprises cannot, in any way, own these important assets. The closest they can come to owning the organization’s human capital is through exercising the notion of “resource sharing” through continuous staff learning, educating, training, and mentoring (Jordan, Ashkanasy&Hartel, 2002, pg. 364). This is the most appropriate way of strengthening the skills, the capacity and the knowledge of human resource that an organization can undertake to tap into its staff potential, thus making a feasible investment in them, an investment that will have an increased personal value that, in turn, helps create human knowledge capital for the organization, as a whole (McNeill & Chapman, 2005).

Capacity, in normal circumstances, refers to the quality that an individual or organization has, at any given time, a feature that might be easily definable, but extremely hard to measure or place a definite monetary value on it (Langley, 2000, pg. 179). Therefore, the capacity will address the frequently asked questions in project management, as to whether it is the organization or the individual that possesses the required capacity levels, and/or the combination of knowledge and skills to accomplish the tasks and duties which is expected of them.  The theory of human capital, on the other hand, can be used to explain the economic worth of the human resource and of an organization, based on its overall performance.  It is noteworthy that this theory focuses mainly on the value addition to the organization’s business, in relation to the earnings attributable to staff, as well as staff learning, education, experience, expertise, innovation, and creativity, all of which are dimensions that form human knowledge capital.



The human capital theory borrows much from the discipline of macroeconomic development theory (Schulz, 1993). This is clearly illustrated by Becker (1993), in his book titled: Human Capital: a Theoretical and Empirical Analysis, especially with reference to education. In this book, he argues that there are various types of capital, namely: schooling, expenditure on health and computer training courses. Interestingly, he also goes on to point out that the virtues of honesty and punctuality are capital as well, essentially because they improve earnings, while still improving health. This opinion is highly consistent with the traditional definition of this concept, to the effect that the expenditure on training, medical care, and education constitutes investment on capital. Therefore, this means that they are not a cost, as such, but an investment that has a value that can not only be quantified but also calculated. From the Classical Economic Theory perspective, human knowledge capital assumes this kind of labor (human knowledge capital) to be a commodity, just like any other that can be traded in terms of sales and purchase. In fact, it particularly focuses on the exploitation of this kind of labor, just like the physical one, by capital. Becker (1993) points, in particular, at human knowledge capital as the most valuable investment in human beings.


Theoretically, it is expected that the higher the human capital stock in the organization, the higher the chances of it being successful and more competitive in its respective sector. Modern organizations are increasingly starting to appreciate the importance of human knowledge capital in improving their overall performance, with every passing day (Watson, 1996). However, despite this increased recognition, organizations are yet to gain a clear understanding of the specific role played by human knowledge capital in the overall performance of the organization.  It is no coincidence, therefore, that this research is informed by the need to explore the best way to gain this understanding. The use of the theory of human knowledge capital in the evaluation of performance is still in its infancy, a fact of which this study is very much aware. Nevertheless, despite that the lack of development in this area, this study realizes its various merits vis-à-vis other concepts that have been in use, previously; for this reason, therefore, the study opts to utilize this theory in its evaluation. Moreover, despite the fact that the actual degree of influence that human knowledge capital has on the overall performance of the organization, in the broader context, might not be very precise, it nevertheless remains the best approach, at the moment.


In normal circumstances, human knowledge capital is understood to comprise individual knowledge, skills, capabilities and the experience of an organization’s staff and management, as they are vital to the organizational task, as well as the capacity to add to the pool of skills, experience and knowledge through individual and collective learning (Dess&Picken, 2000, pg. 8). From this definition, it is clearly evident that human capital is far much wider in scope than even human resources. This over-riding emphasis on knowledge is definitely important, and though the Human Resource literature, arguably, remains focused primarily on the perspective of the individual employee, particularly where job-related knowledge is concerned, the human capital literature has shifted beyond the individual level to embrace the notion that knowledge can also be shared within (and among) teams in the organization, and be incorporated into its policies and practices (Wright, et al., 2001, pg. 713).


The theory and perspective of human knowledge capital emanates from the idea that there is absolutely no substitute for: expertise and experience, learning and education, innovation and creativity; and that they need to be persistently pursued and targeted, in the competitive logic and environmental context of the organization (Rastogi, 2000, pg. 196). This consideration, therefore, leads us to a very important conclusion, namely: that the accumulation of “the best and brightest” in an organization is not, in itself, the be-all and end-all of an organization’s performance issues; but, rather, that there ought to be a real desire on the part of this collective of exceptional talents to invest their expertise, experience, education, innovation and creativity skills in the organization and in their respective positions (Nahapiet&Ghoshal, 1998, pg. 252).  This, essentially, means that the individuals in the organization must be ready, committed and engaged with the organization, if effective exploitation of human capital is to be realized, to its full capacity (Nahapiet&Ghoshal, 1997, pg. 36).


It is also important to look, briefly, at the two other complementary capitals, namely: relational capital and structural capital, both of which might further a more detailed understanding of human knowledge capital, per se.



The social capital theory essentially refers to the importance and centrality of the network of relationships in the conduct of social affairs, whereby most of this capital is entrenched in networks of mutual relationships (Doyle, 1994, pg. 221).  According to Nahapiet&Ghosal (1998, pg. 253), relational capital helps entrench co-operative behavior in the organization, while still increasing the efficiency of actions (Adler & Kwon, 2002, pg. 25). Relational capital and social relationships are, therefore, important factors in the development of human knowledge capital (Becker, 1976, pg. 6). The sentiments of Gratton and Ghosal (2003, pg. 6) are in line with this opinion, when they point out that relational capital is founded on the twin concepts of trustworthiness and sociability (McElroy, 2002, pg. 36). The depth and significance of this link and the potential point of leverage builds significant pools of knowledge, expertise and the potential  for both profit and value creation (Gratton&Ghosal, pg. 7). At an individual level, those employees with stronger contact networks, and this essentially translates as better relational capital, will undoubtedly earn higher rates of return on their human knowledge capital (Garavan, et al., 2001, pg. 53).  It is, however, at the organization level that this capital is most important.  As Nahapiet&Ghosal points out: “…relational capital aids development of human knowledge capital by influencing the necessary conditions for sharing and combining to take place” (pg. 250). In relational capital, the author advocates three major elements, namely:

  1. structural dimension (network ties, appropriate organization, and network configuration);
  2. cognitive dimension (shared narrative and shared codes); and
  3. relational dimension (trust, identification, norms, and obligation).


All these factors complement human knowledge capital, which is very much in line with the current resource-based view (RBV) that emphasizes the importance of grouping and combining resources (Leana& Van Buren 1999, pg. 541). Relational capital, with its emphasis on the interactivity between individuals, facilitates the right conditions to form such links which are tacit, durable and inimitable (Gant &Ichniowski, 2002, pg. 311).



The main aim of structural capital is to increase collective knowledge, share knowledge, efficiently, and enhance the productivity of human knowledge capital, while consolidating learning (McNamara, 1999, pg. 10). It is extremely important to share knowledge, continuously, with the help of operating manuals, internet, S & T, and other such tools, all of which should be used innovatively and continually, in an organized manner (McNamara, pg. 11). Fundamentally, structural capital comprises of four main elements, namely: system, culture, strategy and structure. Because these four elements are closely interconnected, it is always important to have them closely aligned, so that structural capital can be brought into play, while also enhancing the productivity of human knowledge capital, through rapid retention, knowledge-sharing and well- organized procedures (Dess&Picken, 1999, pg. 4).


It is important to note that human knowledge capital is the most important element of intellectual capital in constructing other capitals (structural capital and relational capital) which, in turn, contribute greatly to its growth and development (Crutchfield, 2000, pg. 28).


The main role of structural capital is to bring together the organization’s resources into a process that creates value for the clients and sustainable competitive advantage for the organization (Dess&Picken, 1999, pg. 11).



Typically, these roles include:


  • reporting and organizational structure;
  • operating processes, systems, task design and procedure;
  • infrastructure for both information and communication;
  • performance measurement, incentive, controls systems;
  • information flow and decision processes; and
  • organizational culture, leadership and value.


The links between these various dimensions are imperative, if the staff is to have the motivation that is needed to develop and utilize its knowledge and skills (Dearborn, 2002, pg. 526). Firstly, the culture of an organization normally has a major impact, not only on the area of organizational recruitment and retention, but also in generating commitment. This is confirmed by the findings of the McKinsey War for Talent survey (1999), where 58% of the respondents said they valued a strong sense of culture in an organization, more highly than anything else. Subsequent research has included compelling values and a strong corporate culture as other sources of major corporate success (Collin &Porras, 1994). The general approach of measuring and managing performance and the organization’s incentive structure is another major influence on human knowledge capital (Bontis, 1996, pg. 43).  It can also be confirmed from previous studies that differentiated rewards’ systems, coupled with clear appraisal procedures which are linked to incentive, can also link directly to the organization’s overall performance. As for the organizational structure, the degree that skilled and motivated employers are directly involved in determining what work is performed and how it is accomplished is equally important (Molina-Morales, 2001, pg. 324). To this end, the factors that have been found to have a positive link with an organization’s performance include: staff learning, education, experience, expertise, innovation, and creativity, as well as other factors, such as employees’ participation, team-based working, internal career ladder, etc.


Rumelt (1984) argues that the organizational practices, processes and routines which act as the glue that holds together the various competing interest in the organization can either improve or hinder co-operative working and the creation of knowledge. This, ultimately, is summed up in a simple point, to the effect that organizational structures and processes need to support and promote the purpose of the organization, which, therefore, requires them to have the requisite variety and diversification, without necessarily creating inter-group boundaries and other barriers between individuals (Weisberg, 1996, pg. 24).



The link between human knowledge capital, structural capital and relational capital has certainly been shown to generate intellectual capital which will, in turn, affect knowledge management, in the organization (Orlando, & Johnson, 2001, pg. 186).  Knowledge has, since time immemorial, been a subject of debate by economists regarding its significance in enhancing an organization’s performance.  Of particular interest has been its relevance to the subject of human knowledge capital. Knowledge has been conceptualized and exemplified, in various ways, in the available human capital literature (Maurping, 2002); however, a major point of convergence has been the distinction between tacit knowledge (known for its incommunicability) and explicit knowledge (capable of codification).


Given this significance of knowledge, across the organization, which is in line with the knowledge based theory, the proper management of employees, who are the source of this knowledge, therefore becomes extremely important, in an organization. It is, therefore, incumbent upon any organization to define and identify all forms of knowledge that might be available, within the organization, and also to put in place mechanisms that promote its creation, protection and transfer (Wright, et al., 2001, pg. 713).


The fundamental issue regarding tacit human knowledge capital is its sheer intangibility. Pfeffer& Sutton (1999) stressed the importance of the so-called knowledge-doing gap (transforming knowledge into action), which they argue is no lesser than the actual accumulation of knowledge. This simply means that attending to the environment and conditions under which people are comfortable to act and share their knowledge is a major factor affecting human capital management (Rappleye, 1999, pg. 41). This argument has also been echoed by Wright (2001, pg. 723) who suggested an over-emphasis in HR literature on the development of individual knowledge through training, learning, and educating employees and also on providing employees with incentives to apply that knowledge, at the expense of other important facets of organizational knowledge, such as the sharing of knowledge and increasing its accessibility and transferability (Bagshaw, 2000, pg. 62).

According to Leonard-Barton (1992), there are four main processes that are known to support organizational learning. They include:

  1. owning problems (egalitarianism);
  2. integrating external knowledge;
  3. integrating internal knowledge; and
  4. continuous experimentation.


The greater the relational capital (the sense of social community), the more likely that knowledge will be created, shared or transferred. Similarly, the combination of organizational processes and boundaries which has been put in place might also interfere with knowledge sharing (turning knowledge into action).




The connection between human knowledge capital and performance in an organization is based on two theoretical strands; the first being the resource-based theory, discussed previously; the second being the expectancy theory of motivation.  Expectancy theory of motivation comprises of three components, namely: valence (the value the individual places on the rewards), instrumentality and expectancy.  Valence, in this case, refers to the value attached to reward. The instrumentality refers to the belief that the employee will only receive the reward, after attaining a specific level of performance, while expectancy essentially refers to the belief that the employee will, in one way or another, manage to realize the performance level that is required by the reward system (Nerdrum& Erikson, 2001, pg. 128). HRM practices that encourage high skills and abilities can be specified to make the connection between human knowledge capital management and performance. Below is a chronology of work that has been carried out, over the years, in the field of HR practice and performance.


2.8.1    1960s – 1970s


The pioneering works of economists, Shultz (1969), Mincer (1962) and Nobel Prize winner, Becker (1976), in the area of human resources, set the stage for subsequent research into human capital. The work of these scholars is also credited with pioneering the exploration of the economic returns from investment, in general, and organization-specific training (Huselid, 1995, pg. 645).  Based on empirical analysis, this work was able to redress the prevailing assumption about the pre-eminence of the growth of physical capital in relation to economic success. Human capital has also been instrumental in explaining the earnings’ difference. Employees who invest in training and education will raise their skills’ level and become more productive than those who are less skilled, which therefore means that the high investment in training justifies the high earnings that such employees enjoy (Hiltrop, 1996, pg. 631).


2.8.2    1980s


The rise in human resource management, during this period, introduced several managerial scholars to this debate about the connection between the management of employees and their performance (Becker &Gerhart, 1996, pg. 793). Studies, at this stage, focused mainly on investment in HR practices and business performance.  For instance, Nkomo (1986) used cross-sectional survey data to examine the connection between HR planning and business performance, whereby they found absolutely no relation.


2.8.3    1990s


Research regarding the link between knowledge and an organization’s performance continued into the 1990s, with the main body of research still concentrating on single measures of HR practices. It was around this time that Bartel (1994) established the link between an organization’s adoption of training programmes and growth in its productivity. Significantly, the link between an organization’s training programmes and its financial performance was also established, at the same time, by Gerhart&Milkovich (1992). Weitzmann& Kruse (1990), for their part, established the link between incentive compensation schemes and growth in an organization’s productivity. Generally, selectivity in recruiting was established to be positively linked to organizational performance. However, a major breakthrough, at the time, was the recognition of the fact that a single HR practice was unlikely to predict an organization’s overall performance, something which prompted the researchers to explore the potential for bundles or clusters of HR practices, in combination, to influence an organization’s overall performance, a topic which has dominated this debate, to this day.







Chapter 3




There are two types of data that will be collected in this research, namely: qualitative and quantitative. In this context, the researcher will be seeking information that reflects the quality of the services which the hospital offers (qualitative); and the time that is taken to complete one project, in this medical facility (quantitative) (Rahim & Minors, 2003, pg. 14). One of the issues that the research will be evaluating is the execution of the various tasks involved. In this respect, the researcher will measure how well-informed and experienced an employee is by the quality of the services offered by KFSH & RC, e.g. if the employee delivers an excellent outcome for the maintenance project; or, if he/she guides or advises another member of staff on the best way to improve the services of this medical facility (Cohen, et al., 2007, pg. 12). It will also be incumbent upon the researcher to collect facts from the staff, the management or any other source, at ground level.




The main objective of the study is to ascertain whether staff learning, education, experience, expertise, innovation and creativity, i.e. the components of human knowledge capital, can actually enhance the overall performance of the organization. This is what basically determines the theoretical model in this particular research. Since human knowledge capital is the greatest component of intellectual capital, evaluating the value of these components and their effect on the overall performance will go a long way towards assessing the effect of human knowledge capital on an organization’s overall performance (Harrison, & Sullivan, 2000, pg. 28).



The human knowledge capital will be the measurement scale which, in turn, will be divided into a number of sub-dimensions. All items of the dimensions will have a reference from past research dimensions (Roos& Krogh, 1997). According to the questionnaire design, ten managers of KFRS & RC, with a working experience of at least five years, will be asked to look at the scale of measurement and then comment on anything that, in their opinion, ought to be included in the questionnaire, because of its relevance to KFRS & RC. For instance, they might suggest the inclusion of the hospital’s prompt delivery of services, particularly those affected by the Cyclotron section and the hospital’s Research Center, in general.


As Table 1, below, clearly shows, the measurement scales of human knowledge capital have been divided into learning and education, experience and expertise, and innovation and creation; and, lastly the organization’s performance (Knight, 1999, pg. 28), Almost all items in this dimension have been derived from past research studies.







Table 1:Dimension, sub-dimensions and items of the measurement scale

Dimension Sub-dimension Items in the dimensions  
Human Capital             Learning and Education


              Experience and Expertise


              Innovation and Creation 10
Business Performance             Productivity and Business Value 10






The sample for this research will involve a total of 750 people working within KFSH & RC, and will comprise 10 managers with at least five years working experience, 100 professionals from various professions, 240 subordinate staff, 250 staff and 150 supervisors. The research will make use of a number of sampling techniques, including:


  1. Random sampling: Questionnaires will be issued at random to people working in KFSH & RC, in order to ensure that each person in the organization is offered an equal chance of participating in the research (Donald & Theresa, 2009).
  2. Convenient sampling: because of the frequent movement of staff in a medical facility of this caliber, it might be extremely difficult to conduct an interview with any one member of staff involved in the maintenance project.


In order to overcome this potential difficulty, it will, therefore, be necessary to issue a questionnaire or hold an ad hoc interview with any member of staff whom the researcher happens to come across. This approach, however, is likely to help the researcher achieve randomness, in the research.


However, when it comes to purposive sampling, because of the complexity of some of the issues, the responses to certain research questions will require the input of particular staff. This, therefore, calls for an approach that will ensure that these members of staff are interviewed, without inconveniencing others who might not be in a position to answer such questions.

Since some of the statistical methods, listed above, are no longer either in use or relied upon, the questionnaire survey would provide a failsafe method for the collection and interpretation of data received from the results.


The data will be coded, using the Statistical Package for Social Sciences (SPSS) software (version 16), and processed on a computer. This particular software is recognized as one of the best and most accurate tools for interpreting data from a quantitative study. The preferred scale for such a tool is what is known as a 7-point Likert scale, following a set pattern, with “strongly agree”, “agree”, “neutral”, “disagree” and “strongly disagree”, with a rating of 1 for “strongly agree”, and 7 for “strongly disagree”, and scores represented in descending order (1, 2, 3, 4, 5, 6, 7).



The various responses that the researcher will receive either through the interviews or the questionnaires from the sample staff will be subjected to a 7-point Likert-type scale, ranging from 1 (“strongly agree”) down to 7 (“strongly disagree”). For example, if the researcher wanted to establish whether the hospital was maintaining an outstanding relationship with its clients, 1 would mean that the staff approve, strongly, with the opinion that the hospital has an outstanding relationship with its clients. Conversely, if the overall response to this question was a 7, then this would mean that the majority of the respondents disagreed with the opinion that the hospital has a strong relationship with its clients. In this research study, a total of 750 copies of the questionnaire will be issued, randomly, to the staff of King Faisal Specialist Hospital and Research Centre, in general, covering all the different roles within the facility. Also noteworthy is the fact that these questionnaires will include all the various aspects of the organization, thus further assisting the researcher in understanding and measuring the three areas of human knowledge capital. All the three sections will be used to obtain the respondents’ assessment of the organization’s human knowledge capital. The final section is designed to obtain the respondents’ (managers, in this case) assessment of the organization’s financial performance, vis-à-vis that of its competitors. The independent variable for the research will be human knowledge capital; the dependent variable will be time performance. All independent variables will be measured using a 7-point Likert scale.


Since single performance measure is ordinarily considered an inadequate measure of an organization’s performance, it is always important to incorporate a number of different measures (Collins &Porras, 1994, pg. 25). Through the combination of: industry leadership, future outlook, sales’ growth, market valuation (stock value), employees’ satisfaction, overall response to competition, overall business performance and success, process productivity, profit growth, and success rate in the new services’ launches, the researcher will be able to assess the organization’s revenue, process productivity and profit (Palmer, 2000, pg. 36), which are some of the measures that can be used to capture an organization’s operational and financial performance. Process productivity has been used because of its importance in the medical field, and profit and revenue have been used because they are used, routinely, by Resource-Based-View (RBV) studies, for measuring financial performance (Nordhaug, 1993, pg. 51).  These items have been measured, subjectively, against a 3-year growth period, where this period can be looked on as reflecting the “sustainability” of competitive advantage, primarily because this period (three years) represents a long-term-period (Barney, 1991, pg. 12).



In order to ensure that all the necessary information is captured, without omitting any relevant data, in this research study, a number of data collection methods will be employed (Edvinsson&Sullivan, 1996). Below, are some of the data collection methods that will be employed, in this research study.


  1. Questionnaires: Two types of questionnaires that aim to capture all that the researcher would like to obtain from the respondent will be designed and several copies produced. The researcher will then issue these copies to the two groups.
  2. Interviews: The researcher will have a set of questions that will serve as a guideline, while interviewing the respondents. The different reactions of the respondents will form the answers to these questions and the researcher will complete the interview forms, accordingly, during the course of the interviews. It is, therefore, important to note that at no point will the respondents have the opportunity to fill in the forms, themselves.

3.6       DATA SOURCES 


The data that will be used in this research study will come from two major sources, namely: primary and secondary data (Steward, 1999). Essentially, the primary data will involve:


Observation: Here, the researcher will observe the employee as they go about their duties, carrying out the maintenance project. It is expected that this observation will enable the researcher to monitor the movement of these employees and, hence, the flow of the work in the maintenance project.


The secondary data, on the other hand, will prompt the researcher to search for certain written material relating to the hospital, which might involve the periodicals, financial statements, articles, newsletters and journals, among other written sources of information on certain KFSH & RC records that might prove significant to the researcher in ascertaining the truthfulness of the answer that the managers provide on performance. This is because there is always a chance that managers might be tempted to fabricate information, deliberately, in order to create a more favorable impression of the project, than is actually the case.


The data recording methods that the researcher intends to employ is that of recording the respondent interviews with a tape recorder. The rationale behind using this method is to avoid time-wasting and the inevitable interruptions while the researcher annotates the respondents’ answers (Floyd, 2002). However, this does not obviate the need for note-taking; if anything, the researcher will be required to jot down important notes, from time to time, that will be key to the presentation of the final, comprehensive report on the research findings.

3.8       TARGET GROUP


This research study will involve all KFSH & RC departments and divisions and, therefore, encompasses all of the hospital’s various departmental and divisional personnel, ranging from hospital managers and general staff, to subordinate staff, thereby making them all its target group. Even the hospital CEO will be interviewed, as this member of staff is the most likely respondent, in the entire facility, to offer an insightful overview and background information on KFSH & RC, as well as an opinion on its general performance, in recent years, all of which could prove invaluable, when it comes to assessing the organization’s current performance.



In order to confirm the validity and reliability of the scale, the researcher will conduct a reliability analysis. The researcher will also be able to analyze the various dimensions and sub-dimensions of knowledge capital, in relation to the hospital’s performance, in terms of timescale, through the use of “Pearson Correlation Analysis” (Sullivan, 2000). Following this, the “path analysis” will be called drawn upon, in order to prove the theoretical model, while making an identification of the “causal-effect relationship” of the dimension of knowledge capital and the hospital’s performance (Brown, et al., 2007, pg. 12). The “correlation analysis” will be used to verify the “linear relationship” between the variables that make up the basic hypothesis of path analysis (Oxman, 2002, pg. 32). In brief, this means that the “degree of correlation” will be confirmed by the researcher, first through the “correlation analysis”, while the “causal effect relationship”, for its part, will be confirmed through the “path analysis”.



The diagram, below, summarizes the proposed research model for the research study. Fundamentally, this model hypothesizes that there is a direct and positive link between an organization’s human knowledge capital and its performance (Becker &Gerhart, 1996, pg. 11). By subdividing the higher-order construct of human knowledge capital into its three components (Learning and Education, Experience and Expertise, Innovation and Creation), the first proposed hypothesis is as follows:


Figure 1




(Bontis, N. 2001)






The statistical data of different dimensions and sub-dimensions of human knowledge capital are listed in the table, below, wherein the average score of human knowledge capital stands at 5.38, which includes the highest means and the lowest mean score “staff capability” (5.51), and the lowest mean “staff training and education (4.84)”.


Table 1: Statistical data of different dimensions and sub-dimensions of human knowledge capital


Human Capital


Cronbach’s α Mean S.D.
Learning and Education








Experience and Expertise 0.900






Innovation and Creation 0.842




Business Performance

Financial performance index

Operational performance index











Table 2: Correlation matrix of dimensions that have been measured

  Learning and Education Experience and Expertise Innovation and Creation
Learning and Education

Experience and Expertise

Innovation and Creation Business Performance













*p<0.05; **p<0.0


The above table shows the correlation analysis results for three dimensions of intellectual capital and the business performance. As can be seen, the correlation exhibits a positive trend between three dimensions of business performance and intellectual capital. The trend is remarkable in human capital vs. business performance and relational capital vs. business performance, i.e., 0.439** and 0.418**. Positive correlation is also visible in all the three dimensions of intellectual capital; where coefficients exceed 0.5, particularly the coefficient of structural and human capital, at 0.685**. In terms of correlation that figure is remarkable.


Table 3: Correlation matrix of measured sub-dimensions

  Subdivision 1 Subdivision 2 Subdivision 3 Subdivision 4
Learning and Education        
Experience and Expertise .761**      
Innovation and Creation .643** .491**    
Financial performance index .322** .203 .412**  
Operating performance index .143 .095 .333** .174

*p<0.05; **p<0.01

Illustrated in the table above are the correlation analysis results between dimensions of business performance and various sub-dimensions of intellectual capital, and between “operating performance” and “financial performance” indexes. “Financial performance” and “staff education and training” show high positive correlations; results for “staff capability” under human capital and “co-operation with clients” under relational capital, with the coefficients separately pegged up to 0.412**, 0.322** and 0.346**.


Under human capital, a high correlation can be seen between sub-dimensions of intellectual capital and “operating performance”. Parameters such as “co-operation with clients” and “cultivating a good friendship with clients” under relational capital, are where the coefficients increase, separately, to 0.333**, 0.386**and 0.342**. Overall business performance determines financial performance and operating performance. “Staff education and training” under human capital emerges as the most influential, followed by “co-operation with clients”, under relational capital.


The mean of the “experience and expertise” dimension stands at 5.50, while the mean score of “innovation and creation” stands at 5.49, and that of “learning and education” stands at 5.38. Among these three dimensions of human knowledge capital, “innovation and creation” (5.49) and “experience and expertise” (5.50) show a better performance than “learning and education” (5.38).


The mean score of business performance is a mere 4.54, thus indicating that the hospital is not satisfactory in its performance. At 4.71 “operating performance” scores higher, while “financial performance” scores lower (4.36).




Table 1 illustrates the reliability analysis of the three dimensions, whereby the reliability of the majority of human knowledge capital’s dimensions is higher than 0.8, whereas the overall reliability of the scale is over 0.9, thereby indicating results with a high consistency and reliability. Generally, the scales that were developed in this study have proved to be appropriate measurement tools. Because this research had a total of 750 data items, only elements that were loaded by at least 0.5 were considered, as dictated by Hair, et al., (2006). The reliability test has been analyzed, using internal consistency (Cronbach-α). Furthermore, a limit of 0.7 has usually been used for internal consistency, and 0.6 for exploratory research, which is still acceptable (Hair, et al, 2006).

Description of the respondent

A total of 466 completed questionnaires were returned, as follows:

  • 10 managers with at least five years’ working experience out of 10 = 100%
  • 76  professionals from various professions out of 100 = 76 %
  • 162  subordinate staff out of 240 = 67.5 %
  • 147  staffs out of 250 = 58.8 %
  • 71 supervisors out of 150 = 47.3 %

From the data that has been received, the overall response rate was 62.1%; 63% of the respondents were male and the remaining 37% were female. On average, the age of the respondents was 44 years old, where the youngest respondent was 24 years old; 64% of the respondents had worked in the facility for more than ten years, while 40% of the respondents had worked in other organizations, in the past; 94% of the respondents had attended skill-based courses.




Table 3 is simply a list of the correlation analysis results of the three dimensions of human knowledge capital and the organization’s overall performance. From the table, it is clear to see that there exists a positive correlation between the three dimensions and the organization’s performance, of which a comparably higher positive correlation exists in the Innovation and Creation vs. Organization’s performance and Learning and Education vs. Organization’s performance, i.e. 0.418 and 0.439, respectively.


There also appears to be a positive relationship among the three dimensions. Moreover, all coefficients exceed 0.5, and especially the coefficient of Experience and Expertise and Learning and Education which stands at 0.685, showing a significant level of correlation.




Inevitably, there are potential difficulties associated with a study of this nature and care must be taken to avoid such problems from occurring, during the research process.

Potential set-backs (and possible solutions) include:

  • Insufficient funding for the research: There is no doubt that this research study is complex and ambitious in its remit. This means, therefore, that it may require considerable funding, if it is to be a total success. At the moment, there is no assurance that the researcher will receive the necessary funding, in full, without trimming the requisite budget, or resorting to alternative sources of finance which might come with untenable conditions attached (Grantham, & Nichols, 1997). This, therefore, requires the researcher to seek alternative sources of funding, in advance, in order to avoid a situation where a deficit might occur, as a result of a potential fund provider pulling out, at the last minute, or even offering less funding than the budgeted amount.
  • Unwillingness on the part of respondents: Achieving 100% respondent co-operation is typically unrealistic, in a research study of this type and magnitude, particularly if the participants suspect that the research project in question might expose their individual performance. The researcher has no reason to believe that this particular research study is an exception. Therefore, the researcher must be prepared for a situation where the respondents might be unwilling to give sensitive information concerning certain aspects of their work, in which the researcher might be interested (Dulewicz& Higgs, 1999, pg. 14). It is, therefore, incumbent upon the researcher to assure the respondents a high level of confidentiality, if this challenge is to be overcome.
  • Distorted responses: This is an extension of lack of co-operation on the part of the respondents. In this case, a respondent who is not interested in divulging certain information, for one reason or another, might resort to giving inaccurate answers to the researcher (Fatt, 2002, pg. 28). Such intentional distortion is even more dangerous to the research than outright lack of co-operation, in that it gives an impression that the answers provided are accurate, thereby producing false findings, unreliable interpretations and wrong conclusions and recommendations (Hecker, 1996). The best way to prevent this situation from occurring is to avoid “pushing” for answers from the respondents, in the first place. This will be best achieved by allowing them to answer, on a purely voluntary basis, while leaving unanswered any questions that they might be unable or unwilling to answer.
  • Research personnel: This type of research requires personnel who are well-informed, and with the appropriate numerical and analytical skills; however, mobilizing such individuals is neither easy nor cheap. The same applies to outsourcing the services to a team of suitably trained personnel. Realistically, however, this leaves one option, only – that of training the available personnel for the research task in hand; but this, too, has its difficulties.
  • The fact that this study is limited to one company (KFSH & RC) also limits the generalization of its findings. However, as the medical sector is typically knowledge-intensive, the findings from this research will resonate with and can be applied across a broad spectrum of similar knowledge-driven industries.
  • The human knowledge capital that has been used to calculate the human capital efficiency is far from being a complete measure of an organization’s human knowledge capital, due to the fact that it does not take into account the organization’s relational capital (advertising expenditure) and structural capital (research and development). This is because, as established by Chauvin &Hirschey (1993), Advertising, Research & Development (R& D) have consistently had a very positive impact on business market value, suggesting that investors expect relatively larger cash flows, in the future, from companies with greater advertising and Research & Development (R & D), ceteris paribus. Fortunately, future researchers will be in a position to overcome this difficulty, by conducting their research in an extended manner that helps explain the general condition of human knowledge capital in King Faisal Specialist Hospital and Research Center.






There is no doubt that some respondents might not be comfortable with sharing information which, in their opinion, is sensitive; this also applies to certain experiences about which the researcher might be inquiring. The main reason for this fear is the likelihood that the researcher might fail to maintain confidentiality with the respondents. In this respect, the researcher will have to assure and promise that no such breach of confidentiality, whatsoever, will take place (Guthrie, 2001).




In order for the researcher to gain access to all the relevant information from the respondents, it will be necessary to assure them that their personal details will not be disclosed to anyone else. Furthermore, if it becomes necessary, in extreme circumstances, only, then their clarification and express consent will first have to be sought.


3.12.3 CONSENT


The researcher or his assistant will have to secure a consent form of authorization from the hospital (KFSH & RC) management, before the research can commence, within the hospital premises. Consent from the potential respondents is also obligatory, before the researcher can start interviewing the participants or issuing them with questionnaires.




The researcher will have to satisfy the respondents that they are free to withhold their comments, or even to refuse to participate, at all, in this research without any repercussion, whatsoever. This, therefore, validates the option of withdrawing the comments that they might have made to the researcher, during the course of the research study, once again, without any implication, whatsoever.



Chapter 4






The following chapter presents the findings from the primary research. A questionnaire was sent out to employees of the company to address the research objectives and test the research hypotheses.Thepurpose of the survey was to get an understanding of the attainment and the status of human knowledge capital development in maintenance project in KFSH & RC. In so doing, the influence that exists between human knowledge capital and performance in project management in this facility is examined. Two types of hypothesis were evaluated. The two statistics tools are employee’s t-test and the z- test. In order to achieve this task, a random sample of data is picked from KFSH & RC and used. A sample of 750 KFSH & RC employees and employers were sampled.




From a total of 750 questionnaires issued, 466 were returned. Some fully filled and other half or quarter filled. It was important for proper and finer focus to eliminate all information that were either irrelevant or did not directly contribute to the topic. The duplicated information was also eliminated (Brown, 1999). Two or more half filled or less than half filled questionnaires were combined to be one or two fully filled questionnaires. All contradicting information was eliminated and questionnaires with similar information, one was picked or two combined to form one. Finally, (after analysis), a sample of 201 questionnaire for employees was used for the z- test while that t- test was 143 questionnaires from the employers. In the questionnaire, the performance increment was scaled from 50% to 120%. The employers and employees with close reference to the past records, the overall performance of KFSH & RC was determined.


The 50% was the general increment in the company profitability. It was thus important to recognize the general growth of KFSH & RC considering the factors like increased number of employees, increased production and other related matters (Langley, 2000). The have been many changes in the current organization of the Health care institutions and in KFSH & RC to be specific. This in one way or the other has contributed to the increased profitability and performance of the employees and employers. Some of them are viewed as improvement by the affected communities while other changes are not taken positively because they are seen to happen too soon. The current organization of KFSH & RC has had an economic impact on its system due to the increase in the operation costs as a result of the merger (Truss, 2001). This is why it was important to slot in the other factors.


4.3       DATA CODING


Initial coding was significant in the process of analysis since it provided names for specific pieces of data. These codes comprised of words, expressions or other portions of data. Researcher had to begin with a collection of codes and gradually reduced them until each of them represents a specific concept. These concepts were basically units of meaning. Once a simple coding had been finished then researchers grouped up the codes with common meanings that are linked to a similar phenomenon(Langley, 2000). When varying terms were used to the same concept, the most appropriate label was used as a name for the concept. Instead of coding line by line or sentence by sentence, several researches coded following paragraph by paragraph while there are those who search from meaningful statements in the text.


Even though open coding looked straight forward, at the start it was overwhelming. Its aim was to generate as many codes as possible which will fit the data. As the coding was in process, the study made comparisons of various incidences and it was important to note that some codes were likely to recur more than others. There are also other codes that collapsed and gave room for the development of categories.  Most of the time in the initial data, the researcher was unable to view indicators of specific codes until much later when they occurred in other data. Therefore, the theoretical sampling data that was coded prior to others will be of great importance. It was also crucial to note that the subsequent discoveries will influence how data the previous data were viewed (Rastogi, 2000). The study expected to code and record data during this substantive level, especially the initial interviews conducted.


The results for the employees rating are described in the following section (to be used in z-test). Since training impacts is directly related to the performance of KFSH & RC, the data collected in relation to the increased productivity was valid and appropriate.






The realibility of majority of human knowledge capital’s dimensions was greater than 0.8,. while the overall realibility of the scale was over 0.9, thereby showing a high consistency and realibility results. Generally, the scales that were developed in this research study have proved to be appropriate measurement tools. Because this research had a total of 750 data, only elements that were loaded at least 0.5 were considered, just has (Hair, et al, 2006) dictates. Reliability test has been analyzed using internal consistency (Cronbach-α). While the limit for internal consitency of 0.7 has usually been used, for exploratory research 0.6, which is still acceptable (Hair, et al, 2006).




Although this information has been included in the methodology, it has been decided to restate in in the findings section.  A total of 466 completed questionnaires were returned as follows.


  • 10 managers with at least five years working experience out of 10 =100%
  • 76  professionals from various professions out of 100 = 76 %
  • 162  subordinate staff out of 240 = 67.5 %
  • 147  staffs out of 250 =58.8 %
  • 71 supervisors out of 150 = 47.3 %

From the data that has been received the overall response rate was 62.1%, 63% of the respondents were male while the remaining 37% were female. On average, the age of the respondents was 44 years old where the youngest respondent was 24 years old. 60% of the respondents have been in the facility for the more than ten years, while 40% of the respondents have worked in other firms in the past.  94% of the respondents have attended skilled based courses.
















Figure 3: Overall Response

Figure 4: Time of Employment




In determining whether there is a link between the training, coaching, learning and creativity, innovation and experience of the maintenance staff that undertook the Cyclotron operation section upgrade project of 2011 with the overall performance of KFSH & RC, two hypotheses were used.


H1: μ < 100 (alternative hypothesis) (there is a link between the training, coaching, learning and creativity, innovation and experience of the maintenance staff that undertook the Cyclotron operation section upgrade project of 2011 with the overall performance of KFSH & RC).


HO: μ = 100 (Null hypothesis)  (there is no link between the training, coaching, learning and creativity, innovation and experience of the maintenance staff that undertook the Cyclotron operation section upgrade project of 2011 with the overall performance of KFSH & RC). This is to say, suppose the null hypothesis is correct, then there is a link and if the alternative hypothesis is correct, then there is no link. These hypotheses will be tested at a significant level of 5%.




It is assumed that KFSH & RC investment in learning, education, experience, expertise, innovation, and creativity of its maintenance staff involved in Cyclotron operation section upgrade project of 2011 has gradually assisted in the improvement of KFSH & RC performance. The overall employee/employer performance is distributed about the mean productivity increase. This implies that since the sample is randomly drawn from a normally distributed population the sample belongs to a sampling distribution that exhibit normal distribution about the mean (Rastogi, 2000). This will help further research whether the learning, education, experience, expertise, innovation, and creativity of maintenance staff in the Cyclotron operation section upgrade project of 2011 has contributed to the increased productivity of KFSH & RC in general (second objective).


Consequently, the implication is a sample that is expected to exhibit a mean identical of the source population. While the productivity in respect to the number of months (since the introduction of Cyclotron operation) it bears the property of a standard normal distribution will have a distribution N (0, 1), we assume that the source population for the sample has a distribution N (100, 6).


Two types of test statistics were used to assess the hypotheses. First, the z-test was used for the sample and then another random sample of 23 days was selected, which was assessed through the t-test. For the z-test, the following statistics applied. Assessment of the skewness and kurtosis gives a positive skewness for both the tests. This means that the distribution is skewed to the right. However, the degree of skewness is slight and next to zero hence, the distribution is normal and almost normally distributed about the mean.



Figure 2Z-Test


Table 4 Result  Variable

Result Variable  
  Variable 1
Mean 93
Known Variance 36
Observations 1
Hypothesized Mean Difference 0
Z 0
P(Z<=z) one-tail 0.5
z Critical one-tail 1.644853627
P(Z<=z) two-tail 1
z Critical two-tail 1.959963985


Ho: μ = 100

H1: μ < 100

Z value = (μ1 – μ2)/ (σ/√n)

= (96.32 –100)/ (6/31½)

= -3.414895476


The standard deviation of the sample is -3.414895476 and because of the normal distribution assumption; it is further assumed that the population and the sample have equal standard deviations hence variance.



Figure 4: Z Test




Table 6One-Sample Test
  Test Value = 100
  T Df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference
  Lower Upper
Sample for z-test -4.286 30 .000 -3.677 -5.43 -1.92





The results for the t- test give t value of 3.842 at a significance value of 0.95 with a degree of freedom of 22. This t-value falls within the rejection region.  The result of the z- test gives a value -1.644854. This value falls within the rejection region. The rejection region based on z-test is -1.645. The difference between the two figures is not large enough to disqualify chance as source of the difference.




Since the t-value does not fall within our rejection region, we accept the alternative hypothesis that there is a link between the training, coaching, learning and creativity, innovation and experience of the maintenance staff that undertook the Cyclotron operation section upgrade project of 2011 with the overall performance of KFSH & RC). The value indicates that there is sufficient evidence that the training has aided to the increased production of KFSH & RC since its introduction.


Therefore, the alternate hypothesis applies. Based on the z-test, the observed z-value is -1.644854 against a rejection mark of -1.645. The observed z-value and the rejection mark value have insignificant difference because the figure is converted to three significant figures. For this reason, the observed value falls on the rejection mark and therefore it leads to the rejection of the null hypothesis. Both the results (the results for z- test and those for t- test) give values that fall within the rejection region and hence the null hypothesis is rejected for both (Rastogi, 2000). This gives sufficient evidence to accept that there is a link between training and the overall performance of KFSH & RC. The study therefore ascertains that improving the performance of employees through training will create marked opportunities for its development, and, therefore, foster positive social change and increased production. This confirms the findings from the literature, which point towards the importance of human resource development for performance.


A contribution to positive social change evident through this propose study by providing an environment conducive for learning, teamwork, enhance competence, understanding complex disease and safe practice. Currently, the clinical experience is under performing, given limited opportunities to learn problem solving, and lack of confidence in the clinical arena. Finding measures to reverse the adverse effects of providing clinical experience is beneficial to nursing schools around the world (Thomson, 2000). The basic premise of this research is that improving education of employees will directly increase employee knowledge, ability, and confidence.




Past records on the performance of KFSH & RC offered different research reports and peer-reviewed journals that are fundamental to a study of this nature. A key example of these resources was the research report by Gillies (2003) which elucidates the common basis of cooperative learning, that implemented by nurses in various hospitals.


In such a setting as described above, instructors are akin to moderators who primarily transmit their expertise to the employees when necessary. This is aimed at giving them absolute control over the learning process as it becomes less passive and more participatory. The apparent strong points of the Cyclotron operation section upgrade lie in the knowledge gained or experience got while working. Interactive and participatory approaches to learning serve the purpose of allowing employees to merge theory with practice, so as to avoid any biased preference of one side to the other. It also implies the direct application of the gained information in the appropriate field (Palmer et al, 2000).  Employees are given the opportunity to utilize their newly acquired knowledge for the purpose of discovering more information, than with regard to the topic of study. The Cyclotron operation section upgrade also provided avenues through which employees could understand a topic better, through the inclusion of the person’s point of view.


Cyclotron operation section upgrade provided additional support for cooperation in the learning process by pointing out that the effectiveness of learning depended on its context and embedded activities. Cyclotron operation section upgrade participants were provided with challenging tasks that they are expected to complete in collaboration. It also used problem-solving techniques as its cornerstone. Within the context of collaborative learning, instructors typically began with particular problems that require practical solutions, as opposed to, starting with theoretical frameworks of study and then moving on to the application. This enhanced the participation and application of the gained knowledge.


The studying context provided by Cyclotron operation section upgrade enabled learners or employees in this case to practice their individual problem solving skills while assessing their level of improvement in particular areas of study. Concisely, this taped into another key assumption of Cyclotron operation section upgrade as underscored by Weisberg 1996. Individual employees cannot be standardized as an inflexible sodality since they are different in various ways. These differences are virtually always complementary to each other, which opens yet another thoroughfare that instructors could use during Cyclotron operation section upgrade.


The employees’ diverse backgrounds and experiences are some of the major extraneous factors that influenced the learning process. This effectively invalidates learning approaches that have been traditionally based on standardizing employees. Cyclotron operation section upgrade allowed instructors and employees/employers to understand the different ideas and approaches present with each learner (Weisberg, 1996). Consequently, lessons and study plans could be modified to fit every employee and so its convenience.


Learner motivation has been unequivocally touted as the elixir of effective learning, which is needed to equip learners with the appropriate skills for managing the dynamism of social and professional life. Different people, however, generate and use motivation in variant ways. This fact places the onerous task of discovering and ascertaining the nature of motivation among all employees on the shoulders of educators. Blander and Snell 2009 noted that employees require the constant reinforcement of their motivation to learn in order to guarantee satisfactory acquisition of knowledge.


Education research has advanced incessant calls for increasing the participation of employees in the learning process, especially in institutions of higher learning. These calls come with growing evidence for the capability of collaborative learning techniques to enhance both retention and success in colleges. Collaborative undertakings involve teamwork whereby members have to deal with their individual differences amicably for any significant progress to be realized (Fatt, 2002). The ability of people to either tolerate or resolve their differences spells out the necessary components of a harmonious society achieved through collaboration and teamwork.




Some of the limitations have already been mentioned in the methodology (Chapter 3). However, they are revisited in this section to evaluate which limitations and problems were actually encountered in the research process. The assumptions to the study conducted in this context are diverse and are directly linked to the variables that relate to the training, coaching, learning and creativity, innovation and experience of the maintenance staff that undertook the Cyclotron operation section upgrade project of 2011 with the overall performance of KFSH & RC (Collins &Porras, 1994). The interviewees and those submitting the questionnaires are assumed to have had adequate knowledge of the past performance since the introduction of the program.

The assumption is aimed at the research or study, especially the data analysis, possible. Imitative measures are provided for in the chosen tool of statistical analysis; t-test extenuates the risk of inaccurate results due to this assumptions and rounding offs or various values. The main limitation of the study is the limiting of participants to either employers or employees of the company. All the data submitted by the source (employers and employees) in this case are assumed to be true (Thomson, 2000). This research will illuminate the functionality of a proposed method through which the performance of employers and employees can be improved.




The limitations mentioned above meant that large sums of money would have been necessary, for the study to be a total success. This was not possible for this study and time constraints meant it was not possible to explore different funding options. Apart from these time and monetary constraints the following problems were encountered.


Unwillingness on the part of respondents:As expected the research did not receive a 100% response rate. Apart from usual constraints to response rates, this was due to the sensitive nature of the research, which partly linked respondents’ answers to their individual performance. However, care had been taken to ensure respondents’ of their anonymity and as a consequence a high response rate of 62% was achieved.The researcher secured a consent form from the hospital (KFSH & RC) management before their research study within the hospital premise was commenced. The consent from the potential respondents is another must-have to the researcher before he could embark on interviewing them or issuing them with questionnaires.  In some cases, this was difficult (Wright et al. 2001).


Distorted responses: This is an extension of lack of cooperation on the part of respondents. In this case, a respondent who is not interested in diverging certain information to the researcher for one reason of another might resort to giving inaccurate answers to the researcher (Fatt, 2002. Pg. 28). This intention distortion is even more dangerous to the research than outright lack of cooperation in that it gives an impression that the answers that have been given are accurate, thereby giving false finding, unreliable interpretations and wrong conclusions and recommendations (Hecker, 1996). Apart from the measure taken to get informed consent from respondents and ensuring them of the voluntary nature of their contribution, all incomplete questionnaires were identified and removed. This does not address the problem of distortion, but it did increase validity.


Research personnel:Although it was challenging to complete the research and analyse the data, monetary and time constraints prevented more researchers to be enlisted and trained. This has limited the issue of researcher bias, but also means that the scope of analysis was limited.


Chapter 5



5.0       CONCLUSION


The main objective of the study which was to ascertain whether staffs’ learning, education, experience, expertise, innovation, and creativity, the so-called human knowledge capital constitutes human knowledge capital can enhance the overall performance of the firm was confirm. There is truly a link between the training and the overall performance of the hospital. This is what basically determines the theoretical model in this particular research. Since human knowledge capital is the greatest component of intellectual capital, evaluating the value of this components and their effect on the overall performance will go a long way in assessing the effect of human knowledge capital on the firm’s overall performance (Harrison, & Sullivan, 2000, pg. 28). The knowledge of the various types of healthcare organizations and the mode used in differentiating them is fundamental in analysing the healthcare system operations of KFSH & RC.


Employers and employees need to understand the economic, demographic and social forces that are driving changes in KFSH & RC. In order for a researcher to present clear and accurate information about the KFSH & RC and its services and systems, s/he needs to know certain aspects of healthcare organizations in general. It is important to understand the type of services that the hospital and research centre offers. This is closely related to the general performance of the employers and employees of KFSH & RC. This gives room for future research. This does not deviate much with the Cyclotron operation section upgrade project of 2011, which forms the subject of this research. Installed at 1982 at KFSH & RC and especially the one for 2011, the cyclotron section since the 1983 when started operating, has been a major factor in the success of the entire radiopharmaceutical program. Importantly, the firm can boost its competitive advantage by embracing motivation among the staff especially in the working environment.


The study reveals that there is a link between the learning, education, experience, expertise, innovation, and creativity of the KFSH & RC staffs that undertook the Cyclotron operation section upgrade project of 2011 and overall time performance in a maintenance project on its physical assets. It also shows that KFSH & RC investment in learning, education, experience, expertise, innovation, and creativity of its maintenance staff that were involved in Cyclotron operation section upgrade project of 2011 improve time performance in that particular project and overall output of the medical facility in general. It is also true to certain that the learning, education, experience, expertise, innovation, and creativity of maintenance staff in the Cyclotron operation section upgrade project of 2011 appropriate to the value addition of KFSH & RC in general.


In this study the main task was to determine link between the training, coaching, learning and creativity, innovation and experience of the maintenance staff that undertook the Cyclotron operation section upgrade project of 2011 with the overall performance of KFSH & RC. Where training, coaching, learning and the experience, expertise, innovation, and creativity of the staffs involved in this project refers to the human knowledge capital of KFSH & RC. In most of the researches conducted in the past, a positive relation is existent between employee training and its effect on learning processes. Introduction of Cyclotron operation section upgrade leaded the employee to a clearer understanding of their requirements (Bontis, 2001). This later translates to better performance and quality service delivery by those participating in Cyclotron operation section upgrade.


The performance of workers or employees of an organisation is as critical to its success as is the planning and execution of its strategies, objectives, vision and mission. In order to understand and bring about the synchronization between the ways the members of an organisation function in accordance to its objectives is by understanding how their performances are analysed and managed (Bontis& Fitz-enz, 2002).  According to one respondent, the unity and oneness created by the program helped in boosting the general performance of the Research centre.


The research indicates the existent of a link between the training, coaching, learning and creativity, innovation and experience of the maintenance staff that undertook the Cyclotron operation section upgrade project of 2011 with the overall performance of KFSH & RC. Where training, coaching, learning and the experience, expertise, innovation, and creativity of the staffs involved in this project refers to the human knowledge capital of KFSH & RC. Where employee training is directly related to the general and overall performance of KFSH & RC (Bagshaw, 2000). It is, however, important to point out that, in the research the study focused more than on individuals’ responses and perception of Cyclotron operation section upgrade project of 2011.




Medical care is one of the most sensitive professions in the medical field. Every day, nurses and other clinical professionals have to deal with different challenges that they face in the course of duty. Some of these challenges include their ability to attend to patients at the right time in order to save lives. Patients come to hospitals for treatment on various diseases and ailments. However, during their stay in the hospital, they are vulnerable to other risks such as falls. The medical staff therefore has the responsibility of ensuring that their patients are safe while under their care (Collins &Porras, 1994). The training was important in improving the nurses’ response to the disaster and ways of dealing with any emergencies.


Among the risks that patients are exposed to while in the hands of medical practitioners are injuries and even death caused by falls. There are many people who have experienced falls in their lives when being attended to in medical facilities. According to Bohlander and Snell (2009) these falls are either accidental for instance happen without a fore thought by the victim or are induced to cause further injuries in the patient and/or even death. Therefore, medical officers have the responsibility of coming up with preventive measures to minimize cases of falls within their structures (Bohlander& Snell, 2009). The addressed elements in Cyclotron operation section upgrade project of 2011 helped the participants respond positively to patients and increased their confidence in King Faisal Specialist Hospital and Research Centre (KFSH & RC).


Cyclotron operation section upgrade has improved performance innurses as it incorporated both the simulation effects and the theoretical information that then reinforced their knowledge in practical nursing (Collins &Porras, 1994). With the application of the diverse approaches in teaching of the nursing nurses, it is evident that the employees widened their understanding and therefore was able to aid the patients in meeting their medical needs.




Based on the primary and secondary data the following recommendations can be made:

  • For training and development to be positively linked to performance, programmes have to create a sense of shared goals amongst participants.
  • Training and development cannot be restricted to single courses and events, but has to be embedded in organizational culture and strategy.
  • Opportunities such as Cyclotron should be extended to all members of staff.
  • Training and development has to be directly linked to patient needs and overall organizational objectives.




The fact that this study is limited to one company (KFSH & RC) limit the generalization of its finding. However, the medical industry being knowledge-intensive industry shows just who applicable this research can be to the rest of the industries. Obviously, the research study will have to contend with a number of bottlenecks, all of which might hamper the smooth flow of the entire research process if not well taken care of. There were various bottlenecks and the probably solutions. The following are the areas for further research.


  1. The responsiveness of the employees towards Cyclotron operation section upgrade project of 2011 in KFSH & RC.
  2. The effects of Cyclotron operation section upgrade project of 2011 and its effects on the management of KFSH & RC.
  3. Performance management may be defined as an organized and methodical process used by an organisation or an individual within an organisation to plan, monitor, develop, rate and reward the performances of the employees of that organisation in order to improve, enhance, change and develop the effectiveness with which these employees achieve the organisational goals and objectives in a continuous manner (Adler & Kwon, 2002). Team performance management is an organised approach to managing the performance of different members within a team in order to act as a unitary entity that can aid in the effective and efficient achievement of organisational goals and objectives. Further research would address the impacts of Cyclotron operation section upgrade project of 2011and team performance of KFSH & RC.


Poor customer service delivery and ineffective management of employee diversity result in poor performance of the firm. When this is realized in a firm, there is need to immediately adopt corrective measures in order to avert their negative effects.  And one of the corrective measure is training. The Cyclotron operation section upgrade project of 2011 was therefore vital in improving the overall performance of KFSH & RC (according to an interviewee).


Cyclotron operation section upgrade exploited the social attribute of learning. In essence, as nurses and other employees engaged each other in debates and discussions with regard to a particular problem, they are putting to use their communication and interpersonal skills. These interpersonal interactions among employees are what actually enabled effective learning to occur and therefore better performance (Palmer et al, 2000). The social nature of Cyclotron operation section upgrade encouraged employees collectively to convey their individual capacities; thereby creating an indispensable intellectual synergy that not only makes learning faster, but more interesting. The problem-solving process, therefore, made easier and more stimulating.


In short, Cyclotron operation section upgrade project of 2011 has contributed to the improvements of the productivity of KFSH & RC.




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Appendix A – Survey Questionnaire


General Instruction for Completing the Questionnaire:

  1. Do not write your name.
  2. Read every question carefully before answering.
  3. Put (√) sign in front of the selected answer.
  4. Make sure that you answer all of the questions.

With my best regards,



  1. Your sex?

Male            Female

  1. What is your age?


  1. Number of years working in the hospital?

More than 10 years               less than 10 years


  1. Have you attended any skilled based courses?

Yes         No



1- Strongly agree all the way to 7- strongly disagree

1 The competence of the firm’s staffs is equal to the most ideal level. 1 2 3 4 5 6 7
2 The firm gets the most out of its staffs when they cooperate with one another in a team task. 1 2 3 4 5 6 7
3 Firm’s staffs undergo continuous training programs annually. 1 2 3 4 5 6 7
4 Firm’s staffs continuously learn from colleagues and even outsiders. 1 2 3 4 5 6 7
5 The ratio of educated personnel compares perfectly with the industry (is on average). 1 2 3 4 5 6 7
6 Firm devotes enough time and effort on updates and development of staffs’ knowledge and skills. 1 2 3 4 5 6 7
7 Firm’s market share has been constantly improving over the past several years. 1 2 3 4 5 6 7
8 Staffs’ leaning and education affect firm’s productivity. 1 2 3 4 5 6 7
9 Staffs’ learning and education affects firm’s profitability. 1 2 3 4 5 6 7
10 Staffs’ learning and education affects firm’s market value (stock value). 1 2 3 4 5 6 7



11 Firm’s staffs are experts in their respective fields. 1 2 3 4 5 6 7
12 Firm’s staffs constantly perform at their very best. 1 2 3 4 5 6 7
13 Firm’s staffs generally give it their all, thereby making the firm different from its peers in the industry. 1 2 3 4 5 6 7
14 Firm’s staffs have worked for many years in it (low employees turnover). 1 2 3 4 5 6 7
15 The firm takes pride in its efficiency. 1 2 3 4 5 6 7
16 The firm’s staffs are highly professional. 1 2 3 4 5 6 7
17 The firm has a lowest-costs-per-transaction of any in the entire industry. 1 2 3 4 5 6 7
18 Staffs’ experience and expertise affect its productivity. 1 2 3 4 5 6 7
19 Staffs’ experience and expertise affects its profitability. 1 2 3 4 5 6 7
20 Staffs’ experience and expertise affects its market share. 1 2 3 4 5 6 7



21 Firm’s staffs are considered creative and bright as compared to other firms in the same industry. 1 2 3 4 5 6 7
22 Firm’s staffs are keen to voice their opinion in the group meetings. 1 2 3 4 5 6 7
23 Firm’s staffs usually devise with new ideas. 1 2 3 4 5 6 7
24 Large numbers of new techniques in the medical field are launched in this firm as compared its competitors. 1 2 3 4 5 6 7
25 Firm’s staffs are constantly encouraged to bring new ideas and knowledge to the firm and share it with their colleagues. 1 2 3 4 5 6 7
26 Firm’s staffs are satisfied with their firm’s innovation programs and policies. 1 2 3 4 5 6 7
27 Firm’s staffs are highly motivated and committed to share new great ideas within the firm, as it should. 1 2 3 4 5 6 7
28 Staffs’ innovation and creation affect firm’s productivity. 1 2 3 4 5 6 7
29 Staffs’ innovation and creation affect firm’s performance 1 2 3 4 5 6 7
30 Staffs’ innovation and creation affect the firm’s market image 1 2 3 4 5 6 7




Any comments:……………………………………………………………………………….. ………………………………………………………………………………………………….


Thank you.


For the managers of King Faisal Specialist Hospital and Research Center

Profitability, productivity, and market value index


1 Industry leadership. 1 2 3 4 5 6 7
2 Future outlook. 1 2 3 4 5 6 7
3 Sales growth. 1 2 3 4 5 6 7
4 Firm’s market valuation (stock value). 1 2 3 4 5 6 7
5 Employee productivity. 1 2 3 4 5 6 7
6 Overall response to competition. 1 2 3 4 5 6 7
7 Overall business performance and success. 1 2 3 4 5 6 7
8 Process productivity. 1 2 3 4 5 6 7
9 Profit growth. 1 2 3 4 5 6 7
10 Success rate in new medical services launches. 1 2 3 4 5 6 7




Use “strongly agree”, “Disagree”, “Somewhat agree”, “Agree’, “Strongly agree” or “Not applicable” to answer questions below

Managers section:

  1. Our organization cultivates a good relationship with clients _________
  2. Our organization maintains a good relationship with lawmakers _________
  3. Our organization cultivates a good relationship with cooperative partners _________
  4. Knowledge sharing among staff within the organization is generally good _________
  5. The staff capability is generally good _________
  6. Staff training and education is generally good _________
  7. The overall business process is in good shape _________
  8. The organizational design is generally good _________
  9. The organizational information system framework is generally good _________
  10. The financial performance index of this organization is generally good _________
  11. The operating performance index of this organization is generally good _________

Other staffs section

  1. My seniors shapes job attitudes and relations within my department_________
  2. I am sufficiently motivated for my job _________
  3. My supervisor/manager is fun to work with because he/she particularly encourages both innovation and creativity_________
  4. The training and education that the organization offers me is generally good _________
  5. The overall business process is generally in good shape _________
  6. The department I work in gets adequate support from other departments _________
  7. The promotions in the department I work in have been fair and result-oriented_________
  8. I am adequately compensated for the work I offer the organization_________
  9. I am fully satisfied with my job_________
  10. There is almost no fear of failure in the department I work in which therefore encourages us to experiment on various things_________
  11. I am fully conversant with what the organization is striving to achieve in customer satisfaction and business management_________


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