Institutional Health Voids, Learning Myopia, and Counter-Knowledge: Unveiling Blind Spots in Healthcare Decision-Making
Keywords:
institutional voids; blind spots; counter-knowledge; learning myopia; healthcareAbstract
This study explores how Institutional Health Voids (IHVs) contribute to the emergence of weak signals, which lead to the spread of counter-knowledge and the formation of blind spots among healthcare stakeholders. Focusing on the Spanish National Health System (SNHS), the research investigates how these voids, characterized by fragmented knowledge and misinformation, hinder effective decision-making and exacerbate crises. The study incorporates the concept of learning myopia, which explains the cognitive limitations in interpreting weak signals, thus reinforcing institutional inefficiencies. The findings suggest that IHVs create gaps in knowledge structures, causing delays in response times and misaligned policies, ultimately compromising the system's ability to adapt and respond effectively to health challenges. This study reveals that addressing these gaps requires the development of knowledge structures that not only improve transparency but also foster inter-organizational trust and promote adaptive decision-making processes. By linking the theoretical frameworks of institutional voids with knowledge management, the study offers a fresh perspective on the impact of weak signals, counter-knowledge, and blind spots within the healthcare system. The research contributes to the understanding of how these factors shape decision-making and governance in healthcare systems, providing valuable insights for policymakers aiming to improve healthcare management, particularly in times of crisis. This work underscores the importance of strengthening knowledge structures within healthcare systems to enhance resilience, trust, and long-term sustainability. We explicitly adopt a conceptual methodology based on systematic literature review and critical analysis to integrate theories, clarifying how institutional voids shape healthcare decision-making through weak signals and counter-knowledge.References
Acciarini, C., Brunetta, F., & Boccardelli, P. (2020). Cognitive biases and decision-making strategies in times of change: a systematic literature review. Management Decision, 59(3), 638–652. https://doi.org/10.1108/MD-07-2019-1006/FULL/PDF
Adebowale, V., Alderson, D., Burn, W., Dixon, J., Godlee, F., Goddard, A., Griffin, M., Henderson, K., Horton, R., Marshall, M., Martin, J., Morris, E., Nagpaul, C., Rae, M., Rafferty, A. M., & Taylor, J. (2020). Covid-19: Call for a rapid forward looking review of the UK’s preparedness for a second wave—an open letter to the leaders of all UK political parties. BMJ, 369, 2514. https://doi.org/10.1136/BMJ.M2514
Alstete, J. (2012). Challenges and opportunities in implementing a knowledge management road-map. Journal of Knowledge Management Practice, 13(3). https://journals.klalliance.org/index.php/JKMP/article/view/114
Ammirato, S., Linzalone, R., & Felicetti, A. M. (2021). Knowledge management in pandemics. A critical literature review. Knowledge Management Research & Practice, 19(4), 415–426. https://doi.org/10.1080/14778238.2020.1801364
Andrews, L. R. J., & Luiz, J. M. (2024). Conceptualizing institutional voids in terms of severity and how the home country affects this understanding. Journal of Business Research, 176, 114605. https://doi.org/10.1016/J.JBUSRES.2024.114605
Ansoff, H. I. (1975). Managing Strategic Surprise by Response to Weak Signals. California Management Review, 18(2), 21–33. https://doi.org/10.2307/41164635
Bernal-Delgado, E., Angulo-Pueyo, E., Ridao-López, M., Urbanos-Garrido, RM., Oliva-Moreno J., García-Abiétar, D., & Hernández-Quevedo, C. (2024). Spain: Health system review 2024. Health Systems in Transition, 26(3), 1–216.
Bolisani, E., & Cegarra-Navarro, J. G. (2021). Bad counter knowledge: Case studies and countermeasures. In A. M. Dima & F. D'Ascenzo (Eds.), Business revolution in a digital era (pp. 3–13). Springer. https://doi.org/10.1007/978-3-030-59972-0_1
Bolisani, E., Cegarra-Navarro, J.-G., & Garcia-Perez, A. (2021). Managing counter-knowledge in the context of a pandemic: challenges for scientific institutions and policymakers. Knowledge Management Research & Practice, 19(4), 517–524. https://doi.org/10.1080/14778238.2021.1911606
Bratianu, C. (2017). Emotional and Spiritual Knowledge. Knowledge Management and Organizational Learning, 5(October), 69–91. https://doi.org/10.1007/978-3-319-51067-5_4
Bratianu, C. (2020). Editorial. Managing Complex Crises. Management Dynamics in the Knowledge Economy, 8(4), 321–321. https://doi.org/10.2478/mdke-2020-0020
Castelfranchi, C., & Miceli, M. (2009). The cognitive-motivational compound of emotional experience. Emotion Review, 1(3), 223–231. https://doi.org/10.1177/1754073909103590
Cegarra-Navarro, J. G., & Wensley, A. (2019). Promoting intentional unlearning through an unlearning cycle. Journal of Organizational Change Management, 32(1), 67–79. https://doi.org/10.1108/JOCM-04-2018-0107/FULL/XML
Cegarra-Navarro, J.-G., Bratianu, C., Martínez-Martínez, A., Vătămănescu, E. M., & Dabija, D. C. (2023). Creating civic and public engagement by a proper balance between emotional, rational, and spiritual knowledge. Journal of Knowledge Management, 23(1), 67–89. https://doi.org/10.1108/JKM-07-2022-0532/FULL/XML
Cegarra-Navarro, J.-G., Vătămănescu, E.-M., & Martínez-Martínez, A. (2021). A context-driven approach on coping with COVID-19: From hiding knowledge toward citizen engagement. Knowledge and Process Management, 28(2), 134-140. https://doi.org/https://doi.org/10.1002/kpm.1662
Cegarra-Sánchez, J., Cegarra-Navarro, J. G., & Martinez-Martinez, A. (2025). Addressing patient learning myopia in multiple sclerosis through a thermodynamic approach. Journal of Nursing Care Quality, 40(3), 251-256. https://doi.org/10.1097/NCQ.0000000000000844
Cegarra-Sánchez, J., Martínez-Martínez, A., Cegarra-Navarro, J. G., & Wensley, A. (2024). Implementing an unlearning approach to combat counter-knowledge in multiple sclerosis. Knowledge Management Research & Practice, 1-11. https://doi.org/10.1080/14778238.2024.2420816
Chiappetta Jabbour, C. J., Seuring, S., Lopes de Sousa Jabbour, A. B., Jugend, D., De Camargo Fiorini, P., Latan, H., & Izeppi, W. C. (2020). Stakeholders, innovative business models for the circular economy and sustainable performance of firms in an emerging economy facing institutional voids. Journal of Environmental Management, 264, 110416. https://doi.org/10.1016/J.JENVMAN.2020.110416
Couzin, I. D., Ioannou, C. C., Demirel, G., Gross, T., Torney, C. J., Hartnett, A., Conradt, L., Levin, S. A., & Leonard, N. E. (2011). Uninformed individuals promote democratic consensus in animal groups. Science, 334(6062), 1578–1580. https://doi.org/10.1126/science.1210280
Coventry, L., Branley-Bell, D., Sillence, E., Magalini, S., Mari, P., Magkanaraki, A., & Anastasopoulou, K. (2020). Cyber-risk in healthcare: Exploring facilitators and barriers to secure behaviour. In A. Moallem (Ed.), HCI for cybersecurity, privacy and trust. HCII 2020. Lecture Notes in Computer Science (Vol. 12210, pp. 105–122). Springer. https://doi.org/10.1007/978-3-030-50309-3_8
Czakon, W. (2022). Strategic management and myopia: challenges and implications. Strategic Management and Myopia. https://doi.org/10.4324/9781003199151
Damasio, A. (2010). Self comes to mind: Constructing the conscious brain. Pantheon Books.
Day, G. S., & Schoemaker, P. (2004). Peripheral vision: Sensing and acting on weak signals. Long Range Planning, 37(2), 117–121.
DaDeng, Z. (2024). Pandemic-resilient investment: Sustainable knowledge infrastructure for medical AI. Journal of the Knowledge Economy, 1–24. https://doi.org/10.1007/S13132-024-01874-4/METRICS
Denis, J. L., Côté, N., Fleury, C., Currie, G., & Spyridonidis, D. (2021). Global health and innovation: A panoramic view on health human resources in the COVID-19 pandemic context. The International Journal of Health Planning and Management, 36(S1), 58–70. https://doi.org/10.1002/HPM.3129
Dieleman, M., Markus, S., Rajwani, T., & White, G. O. (2022). Revisiting institutional voids: advancing the international business literature by leveraging social sciences. Journal of International Management, 28(3), 100935. https://doi.org/10.1016/J.INTMAN.2022.100935
Drago, G., Pérez-Sádaba, F. J., Aceituno, S., Gari, C., & López-Belmonte, J. L. (2023). Healthcare resource use and associated costs in a cohort of hospitalized COVID-19 patients in Spain: A retrospective analysis from the first to the third pandemic wave. EPICOV study. PLOS ONE, 18(1), e0280940-. https://doi.org/10.1371/journal.pone.0280940
Dzenopoljac, A., Dzenopoljac, V., Muhammed, S., Abidi, O., & Kraus, S. (2024). Intra-organizational knowledge sharing, ambidexterity and firm performance: evaluating the role of knowledge quality. Journal of Knowledge Management, 28(11), 132–155. https://doi.org/10.1108/JKM-06-2023-0533/FULL/PDF
Ebrashi, R. El, & Darrag, M. (2017). Social entrepreneurs’ strategies for addressing institutional voids in developing markets. European Journal of International Management, 11(3), 325–346. https://doi.org/10.1504/EJIM.2017.083876
Erkoreka, M., & Hernando-Pérez, J. (2023). Decentralization: A handicap in fighting the COVID-19 pandemic? The response of the regional governments in Spain. Public Administration and Development, 43(2), 129–140. https://doi.org/10.1002/PAD.1988
Fotaki, M., & Hyde, P. (2015). Organizational blind spots: Splitting, blame and idealization in the National Health Service. Human Relations, 68(3), 441–462. https://doi.org/10.1177/0018726714530012
Gallo, P., & Gené-Badia, J. (2013). Cuts drive health system reforms in Spain. Health Policy, 113(1), 1–7. https://doi.org/https://doi.org/10.1016/j.healthpol.2013.06.016
Gao, C., Zuzul, T., Jones, G., & Khanna, T. (2017). Overcoming institutional voids: A reputation-based view of long-run survival. Strategic Management Journal, 38(11), 2147–2167. https://doi.org/https://doi.org/10.1002/smj.2649
Gaviria-Marin, M., Merigo, J. M., & Popa, S. (2018). Twenty years of the Journal of Knowledge Management: A bibliometric analysis. Journal of Knowledge Management, 22(8), 1655–1687. https://doi.org/10.1108/JKM-10-2017-0497/FULL/XML
Gillespie, A., & Reader, T. W. (2018). Patient-centered insights: Using health care complaints to reveal hot spots and blind spots in quality and safety. The Milbank Quarterly, 96(3), 530–567. https://doi.org/10.1111/1468-0009.12338
Goode, S., & Lacey, D. (2022). Exploiting organisational vulnerabilities as dark knowledge: conceptual development from organisational fraud cases. Journal of Knowledge Management, 26(6), 1492–1515. https://doi.org/10.1108/JKM-01-2021-0053/FULL/XML
Global Reporting Initiative. (2020). Strong backing for EU ambition to drive transparency. In GRI ready to support European reporting standards on sustainability impacts. https://www.globalreporting.org/news/news-center/gri-backs-mandatory-eu-reporting-on-sustainability-impacts/
Haeckel, S. H. (2004). Peripheral vision: Sensing and acting on weak signals making meaning out of apparent noise: The need for a new managerial framework. Long Range Planning, 37(2), 181–189. https://doi.org/10.1016/j.lrp.2004.01.006
Haney, S., Rowland, P., & Ginsburg, S. (2022). Patients’ perspectives on medical students’ professionalism: Blind spots and opportunities. Medical Education, 56(7), 724-735. https://doi.org/10.1111/medu.14735
Hart, P. (1991). Irving L. Janis’ victims of groupthink. Political Psychology, 12(2), 247–278. https://doi.org/10.2307/3791464
Hujala, T., & Laihonen, H. (2021). Effects of knowledge management on the management of health and social care: A systematic literature review. Journal of Knowledge Management, 25(11), 203–221. https://doi.org/10.1108/JKM-11-2020-0813/FULL/PDF
Hujala, T., & Laihonen, H. (2022). Knowledge management in a regional integrated health and social care system. Journal of Integrated Care, 31(5), 15–28. https://doi.org/10.1108/JICA-06-2022-0032/FULL/PDF
Ilmola, L., & Kuusi, O. (2006). Filters of weak signals hinder foresight: Monitoring weak signals efficiently in corporate decision-making. Futures, 38(8), 908–924. https://doi.org/https://doi.org/10.1016/j.futures.2005.12.019
Janis, I. L., & Hart, P. (1991). Classics in political psychology victims of Groupthink. Political Psychology.
Klammer, A., & Gueldenberg, S. (2019). Unlearning and forgetting in organizations: a systematic review of literature. Journal of Knowledge Management, 23(5), 860–888. https://doi.org/10.1108/JKM-05-2018-0277/FULL/XML
Kosklin, R., Lammintakanen, J., & Kivinen, T. (2023). Knowledge management effects and performance in health care: A systematic literature review. Knowledge Management Research & Practice, 21(4), 738–748. https://doi.org/10.1080/14778238.2022.2032434
Kruse, C. S., Frederick, B., Jacobson, T., & Monticone, D. K. (2017). Cybersecurity in healthcare: A systematic review of modern threats and trends. Technology and Health Care, 25(1), 1–10. https://doi.org/10.3233/THC-161263
Kühl, S. (2020). The blind spots in theory U: The Reconstruction of a (change-) management fashion. Journal of Change Management, 20(4), 314–321. https://doi.org/10.1080/14697017.2020.1744883
Laihonen, H., Kork, A. A., & Sinervo, L. M. (2024). Advancing public sector knowledge management: Towards an understanding of knowledge formation in public administration. Knowledge Management Research & Practice, 22(3), 223–233. https://doi.org/10.1080/14778238.2023.2187719
Larwood, L., & Whitaker, W. (1997). Managerial myopia: Self-serving biases in organizational planning. Journal of Applied Psychology, 62(2), 194–198.
Latukha, M., Shagalkina, M., Mitskevich, E., & Strogetskaya, E. (2022). From brain drain to brain gain: The agenda for talent management in overcoming talent migration from emerging markets. The International Journal of Human Resource Management, 33(11), 2226–2255. https://doi.org/10.1080/09585192.2021.1949374
Levinthal, D. A., & March, J. G. (1993). The myopia of learning. Strategic Management Journal, 14(2), 95-112. https://doi.org/10.1002/smj.4250141009
Mair, J., & Marti, I. (2009). Entrepreneurship in and around institutional voids: A case study from Bangladesh. Journal of Business Venturing, 24(5), 419–435. https://doi.org/10.1016/J.JBUSVENT.2008.04.006
Mair, J., Martí, I., & Ventresca, M. J. (2012). Building inclusive markets in rural Bangladesh: How intermediaries work institutional voids. Academy of Management Journal, 55(4), 819–850. https://doi.org/10.5465/AMJ.2010.0627
Mavin, S., Bryans, P., & Waring, T. (2004). Unlearning gender blindness: New directions in management education. Management Decision, 42(3/4), 565–578. https://doi.org/10.1108/00251740410522287
Meissner, P., Brands, C., & Wulf, T. (2017). Quantifiying blind spots and weak signals in executive judgment: A structured integration of expert judgment into the scenario development process. International Journal of Forecasting, 33(1), 244–253. https://doi.org/10.1016/j.ijforecast.2015.08.002
Morsø, L., Birkeland, S., Walløe, S., Gudex, C., Brabrand, M., Mikkelsen, K. L., & Bogh, S. B. (2022). Compensation claims in Danish emergency care: Identifying Hot spots and blind spots in the quality of care. The Joint Commission Journal on Quality and Patient Safety, 48(5), 271–279. https://doi.org/10.1016/J.JCJQ.2022.01.010
Motta, M., Stecula, D., & Farhart, C. (2020). How right-leaning media coverage of COVID-19 facilitated the spread of misinformation in the early stages of the pandemic in the U.S. Canadian Journal of Political Science/Revue Canadienne de Science Politique, 53(2), 335–342. https://doi.org/10.1017/S0008423920000396
Natarajan, R., & Kumar, J. A. (2025). Knowledge sharing to learn from error: a case study in a professional service triad. VINE Journal of Information and Knowledge Management Systems, 55(2), 310–326. https://doi.org/10.1108/VJIKMS-07-2022-0223/FULL/XML
OCDE. (2023). The country health profile 2023. State of Health in the EU Spain, 1–24. https://doi.org/10.1787/71d029b2-en
O’Dowd, E., Lydon, S., Lambe, K., Rudland, C., Hilton, A., & O’Connor, P. (2022). Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice. Family Practice, 39(4), 579–585. https://doi.org/10.1093/FAMPRA/CMAB109
OECD. (2024). OECD Health Statistics 2024. Https://Www.Oecd.Org/En/Data/Datasets/Oecd-Health-Statistics.Html.
O’Malley, A. S., Grossman, J. M., Cohen, G. R., Kemper, N. M., & Pham, H. H. (2010). Are electronic medical records helpful for care coordination? Experiences of physician practices. Journal of General Internal Medicine, 25(3), 177–185. https://doi.org/10.1007/S11606-009-1195-2
Ortuzar, I., Renart, G., & Xabadia, A. (2021). Effects of public healthcare budget cuts on life satisfaction in Spain. Social Indicators Research, 156(1), 311–337. https://doi.org/10.1007/s11205-021-02624-8
Otero-García, L., Mateos, J. T., Esperato, A., Llubes-Arrià, L., Regulez-Campo, V., Muntaner, C., & Legido-Quigley, H. (2023). Austerity measures and underfunding of the spanish health system during the COVID-19 pandemic—Perception of healthcare staff in Spain. International Journal of Environmental Research and Public Health, 20(3), 2594. https://doi.org/10.3390/IJERPH20032594
Palepu, K. G., & Khanna, T. (1998). Institutional voids and policy challenges in emerging markets. The Brown Journal of World Affairs, 5(1), 71–78. http://www.jstor.org/stable/24589954
Papadimos, T., Soghoian, S., Nanayakkara, P., Singh, S., Miller, A., Saddikuti, V., Jayatilleke, A., Dubhashi, S., Firstenberg, M., Dutta, V., Chauhan, V., Sharma, P., Galwankar, S., Garg, M., Taylor, N., & Stawicki, S. P. (2020). COVID-19 blind spots: A consensus statement on the importance of competent political leadership and the need for public health cognizance. Journal of Global Infectious Diseases, 12(4), 167. https://doi.org/10.4103/JGID.JGID_397_20
Parmigiani, A., & Rivera-Santos, M. (2015). Sourcing for the base of the pyramid: Constructing supply chains to address voids in subsistence markets. Journal of Operations Management, 33–34, 60–70. https://doi.org/10.1016/J.JOM.2014.10.007
Pedrero-García, E. (2017). Health education in the Spanish education system. SHS Web of Conferences, 37, 01066. https://doi.org/10.1051/shsconf/20173701066
Pepple, D., Makama, C., & Okeke, J. P. (2022). Knowledge management practices: A public sector perspective. Journal of Business Research, 153, 509–516. https://doi.org/10.1016/J.JBUSRES.2022.08.041
Pina e Cunha, M., & Chia, R. (2007). Using teams to avoid peripheral blindness. Long Range Planning, 40(6), 559–573. https://doi.org/10.1016/j.lrp.2007.08.004
Prieto-Herraez, S., González-Arteaga, T., & Calle, R. de A. (2020). Public Healthcare: Citizen’s Preferences in Spain. Healthcare, 8(4), 724-735. https://doi.org/10.3390/healthcare8040467
Proeger, T. (2020). Knowledge spillovers and absorptive capacity—Institutional evidence from the “German Mittelstand.” Journal of the Knowledge Economy, 11(1), 211–238. https://doi.org/10.1007/S13132-018-0539-8/TABLES/6
Razzaq, S., Shujahat, M., Hussain, S., Nawaz, F., Wang, M., Ali, M., & Tehseen, S. (2019). Knowledge management, organizational commitment and knowledge-worker performance: The neglected role of knowledge management in the public sector. Business Process Management Journal, 25(5), 923–947. https://doi.org/10.1108/BPMJ-03-2018-0079/FULL/XML
Rodrik, D. (2011). The globalization paradox: Why global markets, states, and democracy can’t coexist. OUP Oxford.
Romanelli, M. (2017). Towards sustainable health care organizations. Management Dynamics in the Knowledge Economy, 5(3), 377–395. https://doi.org/10.25019/MDKE/5.3.04
Sánchez-Polo, M.-T., Cegarra-Navarro, J.-G., Cillo, V., & Wensley, A. (2019). Overcoming knowledge barriers to health care through continuous learning. Journal of Knowledge Management, 23(3), 508–526. https://doi.org/10.1108/JKM-10-2018-0636
Schwenk, C. R. (1984). Cognitive simplification processes in strategic decision‐making. Strategic Management Journal, 5(2), 111-128. https://doi.org/10.1002/smj.4250050203
Scopelliti, I., Min, H. L., McCormick, E., Kassam, K. S., & Morewedge, C. K. (2017). Individual differences in correspondence bias: Measurement, consequences, and correction of biased interpersonal attributions. Management Science, 64(4), 1879–1910. https://doi.org/10.1287/MNSC.2016.2668
Scopelliti, I., Morewedge, C. K., McCormick, E., Min, H. L., Lebrecht, S., & Kassam, K. S. (2015). Bias blind spot: Structure, measurement, and consequences. Management Science, 61(10), 2468–2486. https://doi.org/10.1287/MNSC.2014.2096
Seo, H. J., Kang, S. J., & Baek, Y. J. (2020). Managerial myopia and short-termism of innovation strategy: Financialisation of Korean firms. Cambridge Journal of Economics, 44(6), 1197–1220. https://doi.org/10.1093/cje/beaa023
Smith, N. C., Drumwright, M. E., & Gentile, M. C. (2010). The new marketing myopia. Journal of Public Policy & Marketing, 29(1), 4–11. https://doi.org/10.1509/jppm.29.1.4
Soto-Acosta, P., & Cegarra-Navarro, J. G. (2016). New ICTs for Knowledge management in organizations. Journal of Knowledge Management, 20(3), 417–422. https://doi.org/10.1108/JKM-02-2016-0057/FULL/XML
Tackett, S., Steinert, Y., Whitehead, C. R., Reed, D. A., & Wright, S. M. (2022). Blind spots in medical education: How can we envision new possibilities? Perspectives on Medical Education, 11(6), 365–370. https://doi.org/10.1007/S40037-022-00730-Y/METRICS
Thompson, D. (2008a). Counter-knowledge. Atlantic Books.
Timiyo, A. J., & Foli, S. (2025). Knowledge leakage through social networks: a review of existing gaps, strategies for mitigating potential risk factors and future research direction. VINE Journal of Information and Knowledge Management Systems, 55(2), 511–532. https://doi.org/10.1108/VJIKMS-12-2021-0313/FULL/XML
Tulving, E. (2002). Episodic memory: From mind to brain. Annual Review of Psychology, 53, 1-25. https://doi.org/10.1146/annurev.psych.53.100901.135114
van Veen, B. L., & Ortt, J. R. (2021). Unifying weak signals definitions to improve construct understanding. Futures, 134, 102837. https://doi.org/https://doi.org/10.1016/j.futures.2021.102837
Webb, J. W., Khoury, T. A., & Hitt, M. A. (2019). The influence of formal and informal institutional voids on entrepreneurship. Entrepreneurship Theory and Practice, 44(3), 504–526. https://doi.org/10.1177/1042258719830310
Wiegand, W. A. (1999). Tunnel vision and blind spots. The Library Quarterly, 69(1), 1–32.
World Economic Forum. (2020). COVID-19 pandemic shows we must reduce our blind spots to risk. Forbes. https://www.forbes.com/sites/worldeconomicforum/2020/03/23/
Zajac, E. J., & Bazerman, M. H. (1991). Blind spots in industry and competitor analysis: implications of interfirm (Mis)perceptions for strategic decisions. The Academy of Management Review, 16(1), 37–56. https://doi.org/10.2307/258606
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Juan-Gabriel CEGARRA-NAVARRO, Aurora MARTINEZ-MARTINEZ, Raghda EL EBRASHI , Anthony WENSLEY

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Under the Creative Commons Attribution-NonCommercial-NoDerivs license, the users are free to share (copy, distribute and transmit the contribution) with the condition to attribute the contribution in the manner specified by the author or licensor. They may not alter, transform, or build upon this work.