Sunday, 9 June 2013

Respecting tacit knowledge in knowledge transformation

I used the term knowledge transformation in the title of this blog instead of the common terms knowledge translation or knowledge implementation because, as Morgan Meyer and others have argued, knowledge is rarely used in its original sense.

In a previous blog I discussed Gabbay and Le May's work in general medical practices that led them to understand that doctors create their own "mindlines". I have also read more recently about the SECI model proposed by two Japanese researchers in the 1990s, Nonaka and Takeuchi. They were studying the creation of knowledge within commercial organisations and sought to include the tacit knowledge we all gain through doing and observing but which may be hard to explain, with the explicit knowledge shared through discussion and reading.

This latter model reinforces what Gabbay and Le May found, that doctors' knowledge developed not only through the use of explicit information in the form of guidelines but also the tacit knowledge gained through observing how each other worked and their own interactions with patients and people or organisations outside their practice.

The SECI model stands for: socialisation, externalisation, combination and internalisation. [The diagram here is reproduced from the Gabbay and Le May book].

The idea is that we learn tacit knowledge through a process of socialisation. This involves us observing others working. In an organisation where knowledge creation takes place, they argue, this tacit knowledge needs to be made explicit. This is done by individuals using metaphor and analogy to explain their experiential learning. In turn the externalised knowledge is combined with other information sources.

From my point of view, looking at how to help clinicians use research in decision-making, this includes using research but also using other information sources. The combined knowledge might then be expressed as a lecture, a practise protocol or a guideline generated from this process. Finally, we internalise the combined knowledge as we make sense of it and, if we use it, introduce it in some form into our practise.

Much of the knowledge translation world has ignored, it seems to me, not only the other sources of information that go into making a decision but also the tacit knowledge we all have that may never be expressible. If we take account of pre-existing knowledge - and value this as much as the scientific knowledge we gain - we take a constructivist philosophical view. If we take the view that only scientific knowledge gives us true knowledge then we take a positivist view.

I have moved progressively from the positivist to the constructivist over the last few months as I have learnt more about the way we actually function. It seems to me that even if we wanted to perform every activity according to a positivist stance that everything can be explained by some physical or social law, we would never succeed because we inherently value our own knowledge and experience.

Moving forward, my feeling is that if we - those interested in helping useful and appropriate research to be incorporated into clinical decision-making - are to serve any function then we need to  respect more the complex decision-making and knowledge creation that all clinicians (and human beings generally) are engaged with daily.

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