The role of tacit knowledge in communication and decision-making during emerging public health incidents

Assessing unConventional Evidence (ACE) tool: development and content of a tool to assess the strengths and limitations of 'unconventional' source materials

BACKGROUND

When deciding whether to implement an intervention, decision-makers typically have questions on feasibility and acceptability and on factors affecting implementation. Descriptions of programme implementation and of policies and systems are rich sources of information for these questions. However, this information is often not based on empirical data collected using explicit methods. To use the information in unconventional source materials in syntheses or other decision support products, we need methods of assessing their strengths and limitations. This paper describes the development and content of the Assessing unConventional Evidence (ACE) tool, a new tool to assess the strengths and limitations of these sources.

METHODS

We developed the ACE tool in four stages: first, we examined existing tools to identify potentially relevant assessment criteria. Second, we drew on these criteria and team discussions to create a first draft of the tool. Third, we obtained feedback on the draft from potential users and methodologists, and through piloting the tool in evidence syntheses. Finally, we used this feedback to iteratively refine the assessment criteria and to improve our guidance for undertaking the assessment.

RESULTS

The tool is made up of 11 criteria including the purpose and context of the source; the completeness of the information presented; and the extent to which evidence is provided to support the findings made. Users are asked to indicate whether each of the criteria have been addressed. On the basis of their judgements for each criterion, users then make an overall assessment of the limitations of the source, ranging from no or very minor concerns to serious concerns. These assessments can then facilitate appropriate use of the evidence in decision support products.

CONCLUSIONS

Through focussing on unconventional source materials, the ACE tool fills an important gap in the range of tools for assessing the strengths and limitations of policy-relevant evidence and supporting evidence-informed decision-making.

Unraveling complexity in changing mental health care towards person-centered care

Background

Mental health care (MHC) needs to shift towards person-centered care to better meet people's individual needs. Open Dialogue (OD) is well-aligned with this perspective and brings it into practice. This study focuses on exploring the change process within a pilot project involving three MHC teams as they transition to a person-centered OD practice. Our aim is to identify and reflect on the challenges faced by MHC professionals in adopting person-centered care, and shedding light on the underlying complexity of these challenges. By gaining a better understanding of these obstacles, we hope to contribute to the adoption of the person-centered approach in MHC practice.

Methods

Our research employed a qualitative design, involving a total of 14 semi-structured interviews with MHC professionals who were either trained in OD, OD trainees, or MHC professionals without OD training. To analyze the data, we utilized a hybrid approach that combined deductive - and inductive thematic analysis.

Results

We identified four distinctive challenges: (1) understanding and knowledge transfer, (2) (inter)personal process, (3) emotional discomfort, and (4) the need for multi-stakeholder participation and support. In practice, these challenges intersect and the appearance of and relationships between these challenges are not linear or disentangleable.

Conclusion

Upon careful consideration of these interdependent challenges, it became evident that embedding a person-centered approach like OD brings about systemic change, leading to an unfamiliar situation X. The research findings indicated that understanding and conveying the concept of person-centered care in practical settings poses significant challenges. The field of knowledge management helps to capture the complexity of understanding and transferring this knowledge. The change process necessitates an (inter)personal process and elicits emotional discomfort, as person-centered OD practice confronts a deeply entrenched paradigm in MHC. Achieving a shared understanding of person-centered care requires dedicated time and attention, while introducing this approach prompts broader discussions on underlying values and human rights in MHC. Current implementation efforts may underestimate or overlook these underlying values, but initiating an open dialogue can serve as an initial step in addressing the complexities.

Knowledge transfer between physicians from different geographical regions in China's online health communities

Online Health Communities (OHCs) are a type of self-organizing platform that provide users with access to social support, information, and knowledge transfer opportunities. The medical expertise of registered physicians in OHCs plays a crucial role in maintaining the quality of online medical services. However, few studies have examined the effectiveness of OHCs in transferring knowledge between physicians and most do not distinguish between the explicit and tacit knowledge transferred between physicians. This study aims to demonstrate the cross-regional transfer characteristics of medical knowledge, especially tacit and explicit knowledge. Based on data collected from 4716 registered physicians on Lilac Garden (DXY.cn), a leading Chinese OHC, Exponential Random Graph Models are used to (1) examine the overall network and two subnets of tacit and explicit knowledge (i.e., clinical skills and medical information), and (2) identify patterns in the knowledge transferred between physicians, based on regional variations. Analysis of the network shows that physicians located in economically developed regions or regions with sufficient workforces are more likely to transfer medical knowledge to those from poorer regions. Analysis of the subnets demonstrate that only Gross Domestic Product (GDP) flows are supported in the clinical skill network since discussions around tacit knowledge are a direct manifestation of physicians' professional abilities. These findings extend current understanding about social value creation in OHCs by examining the medical knowledge flows generated by physicians between regions with different health resources. Moreover, this study demonstrates the cross-regional transfer characteristics of explicit and tacit knowledge to complement the literature on the effectiveness of OHCs to transfer different types of knowledge.

Sociotechnical system design to support disaster intervention development teams

Teams are critical in developing effective responses to various disasters and crises. This study defines a new type of response team: a disaster intervention development team, charged with rapidly developing emergent and innovative interventions to aid disaster response. In this case study, we analyzed the SHIELD Enterprise, a disaster intervention development team that developed and deployed a diagnostic testing system for community surveillance and diagnosis to respond to the COVID-19 infectious disease outbreak. We conducted interviews with 27 team members to identify the work system barriers and facilitators they experienced and to analyze the influence on team performance to inform sociotechnical system design for future teams. We identified 215 barriers and 238 facilitators, which we inductively categorized into eight overarching groups, i.e., categories, that included ambiguity, team processes, technology, design and project requirements, knowledge and expertise, organization, task work and environment. Our findings led to eight sociotechnical system design principles to support future disaster intervention development teams.

Knowledge Sharing and the Improvement of Service Delivery in an Academic Library

Knowledge can play an important role in ascertaining an organization’s competitive edge if the knowledge of employees is nurtured and utilized as an asset with a potential to improve service delivery. The study focused on knowledge sharing at the Thomas Mofolo Library in Lesotho to determine if knowledge sharing was being used to improve service delivery at the Library. A case study design that triangulated interviews and questionnaires was used in this study. Quantitative data was processed using software packages. Data from the interviews was analyzed through content analysis based on the objectives of the study. This study established that staff recognized the need to share knowledge. However, knowledge sharing occurred on an ad hoc basis. There was a limited use of technology-based and human-based mechanisms of sharing knowledge. The study suggests practical knowledge-sharing practices that may contribute to improved service delivery in a library setup. As a case study, study may also contribute to the development of theory about the phenomenon.

Tacit knowledge in organizations: bibliometrics and a framework-based systematic review of antecedents, outcomes, theories, methods and future directions

Purpose

The purpose of this bibliometric and systematic literature review is to survey and evaluate key study’s in tacit knowledge (TK). Through analysing and synthesizing based on the antecedents, decisions, outcomes-theories, context and methods (ADO-TCM) framework, this paper highlights research gaps and avenues for future research. It is important to recognize the antecedents, results and theories in the available literature as it offers enough evidence for encouraging the significance of TK.

Design/methodology/approach

This research paper follows a bibliometric analysis and systematic approach in identifying, analyzing and synthesizing pertinent literature in TK. A total of 59 research studies were carefully and systematically reviewed with the help of NVivo12 and excel software to code and analyse.

Findings

With the help of bibliometric analysis and framework-based systematic review, this research paper offers a retrospective view of the TCM framework in the amalgamation with ADO framework, bibliometric analysis and important themes of TK research.

Originality/value

This paper is different from existing reviews as the authors have to combine bibliometric analysis and framework-based systematic review approach to provide a more robust encapsulation of TK research. To the best of the knowledge, the present research is one of the first systematic reviews based on a framework relating to TK.

Planning for Chaos: Developing the Concept of Emergency Preparedness through the Experience of the Paramedic

OBJECTIVE

Emergency preparedness is a developing specialty with a limited evidence base. Published literature primarily offers a retrospective view of experience, with few studies examining and understanding the individual lived experience of practitioners prospectively. This study explores paramedics' lived experience of emergency preparedness and applies that learning.

METHODS

Thirteen paramedics were recruited through purposive sampling. Face-to-face semi-structured interviews explored their individual experiences of emergency preparedness, in line with the idiographic focus of Interpretative Phenomenological Analysis.

RESULTS

Through data analysis, the following superordinate themes were identified for further discussion: self-determination, control, and experience-based practice. Participants appeared to value their role and the unpredictable environment in which they worked. Personal resilience, an area that they suggested is not covered effectively within individual preparation, was viewed as important. The participants articulated that risk, threat, uncertainty, safety, trust, and control were important concepts within individual preparedness. These paramedics valued practice-based knowledge and education as credible and transferrable to their clinical work.

CONCLUSION

Evidence from this study suggests that standard emergency preparedness, with the focus at organizational level, is not sufficient for the individual workers or for an overall effective response. Dimensions of individual preparedness are presented, with the paramedic central to the experience within a conceptual model (the DiEP model), creating a new form of emergency preparedness that reflects the individual paramedic's experience.