Management of Tacit Knowledge to Overcome Learning Barriers Between Professions

The health care sector is under heavy pressure from lawmakers and stakeholders to reduce costs and raise the quality of services. And as such hospitals are obliged to introduce a quality management system. They need to become learning organisations in order to adapt to this new demand. This paper evaluates problems which arise from the professional segmentation and how hospital management tries to cope with it. Therefore the paper ties aspects of knowledge management, to sensemaking in the process of learning. Research will be framed by the system theory approach, which divides learning into two phases: triggering irritation and resultant modification of knowledge structures. Learning is coined by existing knowledge and sensemaking. The first serves as the reference structure, while the latter constitutes the process of relating the new information to the existing knowledge. Both aspects are affected by profession which is imposing specific interpretation and observation schemes on its members. As a result, this leads to asynchronous learning stages and different learning content throughout the organisation. This problem has to be tackled by knowledge management techniques and governance. A case study about quality management and daily working routines was conducted, by using structured narrative interviews. In addition cognitive maps were used to analyse the interpretation patterns in each profession. The coordinating role of quality management was evaluated subsequently. Interviews and maps revealed hidden semantic connections with group-typical knowledge and sensemaking schemes. The definition of "quality" constituted the core of shared knowledge across professions and was oriented towards the cure and professional autonomy. Yet each professional group retained their own set of aims, which led to different dysfunctional learning results. Quality management instruments were used to structure and explicate knowledge on the scale of the whole organisation. This synchronised the system's elements temporarily, in the long run only emergent inter-professional collaboration led to a mutual understanding and made hidden interpretations transparent and consensual affiliations possible. It became clear, that to master the dynamics of organisational learning in health care institutions, strategies of explication of and access to knowledge alone fall short. Thus, management of tacit knowledge is necessary to align different interpretation schemes and ensure cross-professional learning.