Recognising different types of knowledge helps to explain some of the difficulties of changing practice. I will summarise an impressive conceptual article that sadly, is not available via open access. If we think about knowledge in its broader sense, it involves technical, theoretical and practical reasoning. Every day, healthcare professionals use theoretical and scientific knowledge of their discipline, together with their individually developed technical and professional skills and practical reasoning to respond to patients’ healthcare queries.
Another way of looking at this, is that the knowledge that professionals use is influenced by their cognitive learning, social experiences and cultural interactions. Healthcare professionals shape and reshape their knowledge through lived experiences and through interactions with other practitioners, in response to their profession and its history, and in relation to the organisation in which they are working.
Therefore, the knowledge that is required to change practice has at least 3 different components;
- relevant scientific and theoretical knowledge – formal education can be very helpful here, to identify where there is research evidence
- practical know-how – this is often dependent on personal skills and experience, and is usually located in a clinical setting and time
- critical reasoning, to integrate the first 2 types of knowledge in order to recognise the need to amend or change plans
Many of us can recognise that experts have the ability to identify abnormal patterns in either the patient or the environment that others may not even notice. This ability to understand all components of familiar situations and recognise small and significant changes is something that requires extensive experience and a form of reflexive thinking.
Further, to bring these three types of knowledge together requires more than just education. Ideally, relationships between researchers within universities who value scientific knowledge and clinicians and managers within healthcare organisations are required. From this, there needs to be a focus for change that
- brings together key participants with scientific and practical knowledge
- to solve an identified problem
- and reach agreement for action
But first, different alternatives need to be discussed from a variety of perspectives using a common language, that builds mutual understanding and respect of different benefits and barriers. Then, it is possible to negotiate about the priorities for change and agree on an appropriate action that can be implemented and monitored. It is important to monitor the process and measure the specific outcomes achieved.