Q Manage Health Care Vol. 17, No. 3, pp. 252–269 c  2008 Wolters Kluwer Health | Lippincott Williams & Wilkins The Strategic Management of Organizational Knowledge Exchange Related to Hospital Quality Measurement and Reporting Pavani Rangachari, PhD Context/Purpose: With the growing momentum toward hospital quality measurement and reporting by public and private health care payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding accuracy. This study explores the relationship between the organizational knowledge-sharing structure related to quality and hospital coding accuracy for quality measurement. Simultaneously, this study seeks to identify other leadership/management characteristics associated with coding for quality measurement. Theory and Methods: Drawing upon complexity theory, the literature on “professional complex systems” has put forth various strategies for managing change and turnaround in professional organizations. In so doing, it has emphasized the importance of knowledge creation and organizational learning through interdisciplinary networks. This study integrates complexity, network structure, and “subgoals” theories to develop a framework for knowledge-sharing network effectiveness in professional complex systems. This framework is used to design an exploratory and comparative research study. The sample consists of 4 hospitals, 2 showing “good coding” accuracy for quality measurement and 2 showing “poor coding” accuracy. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. Findings and Implications: Findings of this study indicate that good coding performance is systematically associated with a knowledge-sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment), rather than in density (where everyone is directly connected to everyone else). It also implies that for the hospital organization to adapt to the changing environment of quality transparency, senior leaders must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and connect these subgroups with the changing external environment. Key words: hospital quality measurement, knowledge management, network structure/effectiveness, professional complex systems, public reporting G rowing concerns over the variation in health care quality across the nation 1,2 and increasing involvement of con- sumers in health care decision making 3 have resulted in a strong impetus in the health care industry toward hospital quality measurement, 4 pub- lic reporting of hospital performance, 5 and persistent efforts to align hospital quality and reimbursement. 6 These rapidly growing trends reflect concerns and Author Affiliation: Healthcare Management and Informat- ics, Medical College of Georgia, Georgia. Corresponding Author: Pavani Rangachari, PhD, Health- care Management and Informatics, Medical College of Georgia, Georgia. (pranganu@yahoo.com). The author thanks more than 60 health care administrators and professionals for their assistance, whose names cannot be men- tioned because of confidentiality reasons but without whom this study would not have been possible. The author also thanks Drs Sue R. Faerman, R. Karl Rethemeyer, and David P. McCaffrey for their invaluable support, advice, and guidance throughout this project. The author is also grateful to the SUNY-Albany Institu- tional Review Board for oversight and support of this study. 252