Proceedings of the 12th European Conference on Knowledge ...

Roman Kislov
role boundary blurring between pr<strong>of</strong>essions; and, finally, that <strong>the</strong>re is variation among staff whe<strong>the</strong>r
<strong>the</strong>y consider <strong>the</strong>mselves firstly as a member <strong>of</strong> a particular pr<strong>of</strong>ession, or mainly as a member <strong>of</strong> a
local team.
The formation <strong>of</strong> a multipr<strong>of</strong>essional and multi-organisational CoP implies that <strong>the</strong> CoP members will
have to build a new CoP identity which reconciles <strong>the</strong>ir pr<strong>of</strong>essional and organisational identities. It is
not clear, however, what trajectories <strong>the</strong>se new identities take within newly formed CoPs, to what
extent socialisation to a new CoP can override pr<strong>of</strong>essional and organisational differences amongst
staff, and whe<strong>the</strong>r <strong>the</strong>se new, ‘collaborative’ identities within a multipr<strong>of</strong>essional and multiorganisational
CoP are predetermined by dominance, power and status issues.
2.3 CoP knowledge sharing
The CoP concept emerged within <strong>the</strong> situated <strong>the</strong>ory <strong>of</strong> learning which views practice, i.e. a domain <strong>of</strong>
collective knowing and doing, as <strong>the</strong> means through which knowledge dynamics in an organisation
unfold (Wenger 2000). Apart from explicit, codifiable, ‘know-that’ knowledge, collective practice
generates a great deal <strong>of</strong> tacit, ‘know-how’ knowledge, which is embodied in <strong>the</strong> CoP members’
practical skills and expertise (Brown and Duguid 2001). As a result, homogeneous and wellestablished
CoPs create distinct epistemic cultures, i.e. cultures which ‘create and warrant
knowledge’, making up ‘how we know what we know’ (Knorr Cetina 1999, p. 1). Knowledge can flow
relatively easily within such cultures, while it can become sticky at <strong>the</strong> boundaries between <strong>the</strong>m
(Duguid 2005). These boundaries can be classified as syntactic (difference in language), semantic
(difference in meaning) and pragmatic (difference in practice), <strong>the</strong> latter being most difficult to
overcome (Carlile 2002).
The presence <strong>of</strong> distinct epistemic cultures and boundaries in healthcare has been confirmed by a
number <strong>of</strong> empirical studies. It has been shown, for instance, that doctors, nurses and managers have
different attitudes to organisational change which are deeply embedded in <strong>the</strong>ir pr<strong>of</strong>essional cultures
(Degeling et al. 2001; Hall 2005; Morgan and Ogbonna 2008) and that <strong>the</strong>re are multiple differences
<strong>of</strong> values, structures, education and relationships between <strong>the</strong> acute and primary care sectors
(Fitzgerald et al. 2002). Unipr<strong>of</strong>essional CoPs are predominantly unidisciplinary, tend to seal
<strong>the</strong>mselves <strong>of</strong>f from neighbouring pr<strong>of</strong>essional communities and are highly institutionalised. This
causes <strong>the</strong> ‘stickiness’ <strong>of</strong> knowledge across boundaries and hence retards <strong>the</strong> innovation spread
(Ferlie et al. 2005).
Wenger (1998; 2000) distinguishes <strong>the</strong> following types <strong>of</strong> bridges across boundaries:
Knowledge brokers—people who facilitate interaction and coordinate practice between
communities.
Boundary objects—artifacts, discourses and processes possessing interpretative flexibility which
allows <strong>the</strong>m to overcome boundaries and hence contribute to knowledge transfer across CoPs
(Star and Griesemer 1989; Swan et al. 2007).
Boundary interactions among people from different CoPs—<strong>the</strong>se include single or discrete
boundary encounters (e.g. meetings, visits and delegations) and longer-lived practice-based
connections.
Knowledge transfer in cross-disciplinary boundary interactions in healthcare has been explored in a
number <strong>of</strong> recent empirical studies. For example, Gabbay et al. (2003) show that knowledge transfer
in CoPs does not follow <strong>the</strong> model <strong>of</strong> evidence-based practice, but exhibits <strong>the</strong> more socially
determined pattern <strong>of</strong> collective sense-making which is shaped by personal, political and pr<strong>of</strong>essional
agendas. Tagliaventi and Mattarelli (2006) argue that operational proximity in combination with
holding common values regarding shared practice acts as a leveraging tool for knowledge transfer
between doctors, technicians, physicists and nurses in a multipr<strong>of</strong>essional CoP.
Finally, Oborn and Dawson (2010) highlight that while learning in unidisciplinary CoPs develops
through repetition, gaining legitimacy and achieving mastery, learning in multidisciplinary teams is
facilitated by <strong>the</strong> following practices: (1) organising discussions; (2) acknowledging o<strong>the</strong>r
perspectives, and (3) challenging assumptions. Knowledge brokers in multidisciplinary teams are
<strong>of</strong>ten central to <strong>the</strong>ir respective unidisciplinary CoPs and use boundary objects to make <strong>the</strong>ir practices
more visible, interrelate and bridge <strong>the</strong> neighbouring unidisciplinary communities, and hence enable a
shift in understanding across CoPs.
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