Tacit and Explicit Knowledge in Health Care

Explicit knowledge is knowledge that can be codified; the periodic table, or the life cycle of the malarial parasite, for example. Tacit knowledge is not codified – it is a form of expertise that lies subconsciously within human capability. It can be enhanced by practice, but it is not explicated algorithmically. Some tacit knowledge is neuromuscular – skating for example. But some is cognitive, for example being a good manager, or spotting that a patient is deteriorating beyond the level indicated by the vital signs alone. So far, so good, but academics get paid by examining matters more deeply, as in a recent article in the journal Organization Science.[1] So here are some further points about tacit and explicit knowledge based on empirical psychological research:

1. Many tasks require an integration of both types of knowledge – dealing with aggression is a good example – there are some tricks you can use, but how you deploy them is a judgement. Surgery and aviation involve integration of tacit and explicit knowledge from moment to moment.
2. They exist on a continuum – what is happening in the brain may not be either entirely intuitive or explicit when action is taken.
3. They are often (but not always) inter-changeable. Learning by rote can result in actions that become intuitive over time. And actions that a person considers intuitive may be broken down into mental processes that hover between the conscious and sub-conscious worlds.
4. Clues from the environment, especially the social environment, enable the brain to codify knowledge that was previously sub-conscious.
5. There are large advantages in moving knowledge from the tacit into the explicit domain. For a start, this makes it less costly to share with others. It enables us to quickly convey meaning to ourselves and others, by means of language not trial and error. Humans are codifiers of knowledge.
6. Explicit knowledge can detect and correct errors that are made unconsciously.
7. Tacit knowledge is acquired by participating in social practices guided by more experienced people.
8. Tacit knowledge is dispersed in organisations where individual bounded rationality is overcome through partitioning of tasks and channelling of information within hierarchies.

These concepts are crucially important to CLAHRCs where service improvement involves an interchange of information within organisations and where we tackle complex problems, such as improving care for people with mutli-morbidity. The latter provides a superb example of a task requiring a synthesis of tacit and explicit knowledge.

— Richard Lilford, CLAHRC WM Director
Thanks to Gill Combes for pointing this paper out.

Reference:

1. Nonaka I, & von Krogh G. Tacit Knowledge and Knowledge Conversion: Controversy and Advancement in Organizational Knowledge Creation Theory. Organ Sci. 2009; 20(3): 635-52.