title: How does the knowledge environment shape procurement practices for orthopaedic medical devices in Mexico?
abstract: In organisational theory there is an assumption that knowledge is used effectively in healthcare systems that perform well. Actors in healthcare systems focus on managing knowledge of clinical processes like, for example, clinical decision-making to improve patient care. We know little about connecting that knowledge to administrative processes like high-risk medical device procurement. We analysed knowledge-related factors that influence procurement and clinical procedures for orthopaedic medical devices in Mexico.
  
  
  
  We based our qualitative study on 48 semi-structured interviews with various stakeholders in Mexico: orthopaedic specialists, government officials, and social security system managers or administrators. We took a knowledge-management related perspective (i) to analyse factors of managing knowledge of clinical procedures, (ii) to assess the role of this knowledge and in relation to procurement of orthopaedic medical devices, and (iii) to determine how to improve the situation.
  
  
  
  The results of this study are primarily relevant for Mexico but may also give impulsion to other health systems with highly standardized procurement practices. We found that knowledge of clinical procedures in orthopaedics is generated inconsistently and not always efficiently managed. Its support for procuring orthopaedic medical devices is insufficient. Identified deficiencies: leaders who lack guidance and direction and thus use knowledge poorly; failure to share knowledge; insufficiently defined formal structures and processes for collecting information and making it available to actors of health system; lack of strategies to benefit from synergies created by information and knowledge exchange. Many factors are related directly or indirectly to technological aspects, which are insufficiently developed.
  
  
  
  The content of this manuscript is novel as it analyses knowledge-related factors that influence procurement of orthopaedic medical devices in Mexico. Based on our results we recommend that the procurement mechanism should integrate knowledge from clinical procedures adequately in their decision-making. Without strong guidance, organisational changes, and support by technological solutions to improve the generation and management of knowledge, procurement processes for orthopaedic high-risk medical devices will remain sub-optimal.
authors.affiliation: University of Basel, Petersplatz 1, 4003, Basel, Switzerland. myriam.lingg@yahoo.de.|Swiss Tropical and Public Health Institute, Swiss Centre for International Health, Socinstrasse 57, 4051, Basel, Switzerland. myriam.lingg@yahoo.de.
authors.forename: Myriam
authors.initials: M
authors.lastname: Lingg
authors.affiliation: University of Basel, Petersplatz 1, 4003, Basel, Switzerland.|Swiss Tropical and Public Health Institute, Swiss Centre for International Health, Socinstrasse 57, 4051, Basel, Switzerland.
authors.forename: Kaspar
authors.initials: K
authors.lastname: Wyss
authors.affiliation: National Autonomous University of Mexico, Medical faculty, Circuito Interior, Ciudad Universitaria, Av. Universidad 3000, CP 04510, Mexico, Mexico.|Centre for Mexican Studies in the United Kingdom, London, WC2R 2LS, UK.
authors.forename: Luis
authors.initials: L
authors.lastname: Durán-Arenas
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D004864:Equipment and Supplies; D006801:Humans; D019359:Knowledge; D008800:Mexico; D009934:Organization and Administration; D019637:Orthopedic Procedures; D036301:Qualitative Research
keywords: Healthcare systems; Knowledge management; Medical devices; Orthopaedic; Procurement