Leveraging tacit knowledge to improve healthcare quality in surgery: an explorative ethnographic study

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Background Tacit knowledge (TK) is based on experience, intuition, and know-how. Healthcare professionals use it for decision-making in complex situations; still, it is often overlooked as a factor contributing to healthcare quality. Organizational knowledge creation theory explains how knowledge converts between tacit and explicit knowledge. Certain leadership behaviors help create supporting contexts that enhance leveraging TK for quality improvement. Therefore this study explores how healthcare professionals leverage TK for healthcare quality (improvement), and what role does leadership play in facilitating this process? Methods An exploratory ethnographic single-case study was conducted in a surgical department of a Dutch teaching hospital, consisting of 55 hours of non-participant observations and informal conversations. Results Leveraging TK was empirically observed in practices such as treatment choices and reflections on patient care. This occurred in planned settings, such as handovers, multidisciplinary meetings and spontaneous interactions. Leadership emerged as an important facilitator in these TK sharing processes by creating supporting contexts, with different leadership behaviors in planned and spontaneous interactions. Conclusions TK is an integral part of both planned and spontaneous discussions in clinical care. It thereby is an important factor in quality of care and should be fostered explicitly by leadership. The developed taxonomy of leadership behaviors provides practical insight into how leaders can create supportive contexts for using TK in daily practice.

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